Patient Engagement

Dr. Mohamed Mosaad Hasan

MD, MPH, CPHQ, CPPS

OVERVIEW

• We are all consumers as patients and family members – encourage thinking as consumers

• We should all be active patient safety advocates, as providers of services and products, as well as consumers

LET’S BE RESPONSIBLE PROVIDERS OF INFORMATION

• As patients, let’s know, document and update our medical history, active medications and our allergies.

• Understand that medication improper usage, over-use, misuse and hand-off’s are huge source of medication errors worldwide.

SPEAK UP

Launched in 2002, The Joint Commission’s Speak Up™ program urges patients to take an active role in preventing health care errors.

SPEAK UP• Speak up if you have questions or concerns. If you still

don’t understand, ask again. It’s your body and you have a right to know.

• Pay attention to the care you get. Always make sure you’re getting the right treatments and medicines by the right health care professionals. Don’t assume anything.

• Educate yourself about your illness. Learn about the medical tests you get, and your treatment plan.

• Ask a trusted family member or friend to be your advocate (advisor or supporter).

SPEAK UP

• Know what medicines you take and why you take them. Medicine errors are the most common health care mistakes.

• Use a hospital, clinic, surgery center, or other type of health care organization that has been carefully checked out. For example, The Joint Commission visits hospitals to see if they are meeting The Joint Commission’s quality standards.

• Participate in all decisions about your treatment. You are the center of the health care team.

• Don’t be intimidated. – “Doctor, did you wash your hands?” – Ask about anesthesia, IV drips, special tests,

x-rays with dyes, etc. – Insist on full disclosure. We have a right to

know exactly what happens to our body. “Nothing about me without me.”

LET’S BE EXPECTANT AND PRESUMPTUOUS

• Expect our privacy and confidentiality be honored at all times

• Expect current, evidenced-based medicine, unless logical and convincing reasons for other approaches

• If a mistake happens without our knowledge, even without harm, we should be told -- ethical thing to do.

• What is the patient’s experience and understanding of medical error?

• Can patients play a role in identifying medical error and preventing harm?

Conditions for patients to preventmedical errors

Ability to behave safely

Ability to communicate

errors

Ability to identify errors

Can patients identify and communicate errors

• National telephone survey of 1,207 patients in 2002

• 42% of patients reported medical errors in their own or a family member’s care

MDs “responsible” for most errorsFew disclosed error or apologized

• Design Med/surg patients at 16 Massachusetts

hospitals• Sample 2,582 (62%) completed a post-discharge

telephone survey 998 also agreed to medical record review

Analysis MD panel classified reports

• In sum, many patients can identify and report “safety” events.

• Some screening may be necessary.

Behaving Safely

Factors that Affect Patient Taking Action

• Gravity of perceived threat.• Preventability.• Effectiveness of action.• Consequences of speaking up.• Self-efficacy.• Staff members’ instructions and

expectations.

How Can We Promote Engagement?

Condition (H) Help

• Condition Help (H) is a program that enables patients and family members to call for immediate help if they feel the patient is not receiving adequate medical attention.

• Modeled on the Rapid Response Team, a group of clinicians available to rush to a patient’s bedside whenever a nurse or other caregiver feels a patient’s condition is deteriorating, UPMC’s Condition H gives patients and families a way to alert a similar team who will come and assess the situation

Questions

• How much can (and should) we rely on patients to ensure their own safe care?

• Does patient participation signal a failure of our systems to prevent or trap errors?

• Can we customize the approach for different patients with different capacities?

• What safety behaviors (for patients) hold the most promise?