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Patient Safety

Patient Safety Accountability: Patient Safety and Policy Reform edited by Virginia A. Sharpe (Hastings Center Studies in Ethics), 276 pp, $49.95, ISBN 1-58901-023-X, Washington, DC, Georgetown University Press, 2004. The 1999 report from the Institute of Medicine (IOM) galvanized a national effort to promote patient safety and decrease the incidence of medical errors. A variety of public and private initiatives have subsequently developed consensus patient safety indicators, identified safety goals, and reported safety data to the public. Most of the patient safety literature, including the oft quoted IOM report, focuses on the accountability of organizations and the inherent flaws of complicated health care delivery systems. In a novel addition to this literature, Virginia Sharpe has assembled a collection of essays that explore the ethical issues and underlying values that shape patient safety reforms. The essays in this book focus on the tension between institutional and individual accountability, which, as the editor argues in the introduction, must be resolved before real change can occur. Traditional medical professionalism holds that physicians, as individuals, are responsible for health care quality. This ethos has resulted in the widespread “shame and blame” model, which focuses on identifying “bad apples” and relies on tort liability as both a deterrent and a compensation mechanism for victims. Moving to a notion of institutional accountability rather than individual accountability will require a profound culture change. The first three chapters are powerful first-person narratives of the suffering that can result from medical errors. Family members’ frustration with the lack of disclosure, minimal empathy from health care providers, and little acknowledgement of individual accountability is palpable. Subsequent chapters describe the institutional and cultural forces within the health care system that allow medical errors to occur and at the same time discourage reporting. Some chapters focus on underlying ethical principles or values as they pertain to policy reforms while others describe the implementation of values-based patient safety interventions. Nancy Berlinger’s discussion of the healing power of forgiveness, for both victims and health care professionals, is a particularly interesting topic not often discussed in the patient safety literature. The role of forgiveness brings into sharp relief the dynamic tension between individual and organizational accountability. Victims and their families need the individual acknowledgment that something went very wrong. Family members describe how difficult it is to get answers and point to the litigation process as the only avenue to the information that they needed to hear about the mistake that injured their loved one. Clinicians and analysts, on the other hand, describe the complex chain of events that contribute to most medical errors. In their eyes, individual accountability leaves the last person to touch the process “responsible” for any error. Individual accountability promotes the “shame and blame” environment and stymies efforts to truly improve care. How then to reconcile this dilemma? Unfortunately the essays raise many more interesting questions than they answer. The ethical limitations of moving from individual to institutional accountability are explored in several of the essays. Will individual providers absolve themselves from a responsibility to improve care? Is there reason to believe that organizations are inherently more ethical than individuals? The final chapters consider alternative legal options for compensating victims. Offering a unique perspective, this section of the book does not review the empirical evidence for or against tort liability but instead addresses tort reform from an ethical framework. All three authors argue that tort liability fails as an ethical compensation mechanism or deterrence mechanism, and its adversarial nature makes it difficult to turn errors into improvement. The implications of expanding mediation or a “no-fault” program are discussed. Again, the ethical implications of trading justice for one in return for the greater good of others become explicit. Accountability is a useful resource for readers interested in using an ethical framework to review general patient safety topics. The chapters are uneven and don’t make a coherent whole, which is not surprising given the diverse group of authors, topics, and perspectives that are represented. The book would have benefited from a concluding chapter to pull together the common threads and highlight conflicting perspectives. Most readers will be interested in selected essays rather than the book as a whole. The chapters are well referenced, though, so the interested reader is able to explore particular issues in more depth. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Patient Safety

JAMA , Volume 293 (8) – Feb 23, 2005

Patient Safety

Abstract

Accountability: Patient Safety and Policy Reform edited by Virginia A. Sharpe (Hastings Center Studies in Ethics), 276 pp, $49.95, ISBN 1-58901-023-X, Washington, DC, Georgetown University Press, 2004. The 1999 report from the Institute of Medicine (IOM) galvanized a national effort to promote patient safety and decrease the incidence of medical errors. A variety of public and private initiatives have subsequently developed consensus patient safety indicators, identified safety goals, and...
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Publisher
American Medical Association
Copyright
Copyright © 2005 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.293.8.1010
Publisher site
See Article on Publisher Site

Abstract

Accountability: Patient Safety and Policy Reform edited by Virginia A. Sharpe (Hastings Center Studies in Ethics), 276 pp, $49.95, ISBN 1-58901-023-X, Washington, DC, Georgetown University Press, 2004. The 1999 report from the Institute of Medicine (IOM) galvanized a national effort to promote patient safety and decrease the incidence of medical errors. A variety of public and private initiatives have subsequently developed consensus patient safety indicators, identified safety goals, and reported safety data to the public. Most of the patient safety literature, including the oft quoted IOM report, focuses on the accountability of organizations and the inherent flaws of complicated health care delivery systems. In a novel addition to this literature, Virginia Sharpe has assembled a collection of essays that explore the ethical issues and underlying values that shape patient safety reforms. The essays in this book focus on the tension between institutional and individual accountability, which, as the editor argues in the introduction, must be resolved before real change can occur. Traditional medical professionalism holds that physicians, as individuals, are responsible for health care quality. This ethos has resulted in the widespread “shame and blame” model, which focuses on identifying “bad apples” and relies on tort liability as both a deterrent and a compensation mechanism for victims. Moving to a notion of institutional accountability rather than individual accountability will require a profound culture change. The first three chapters are powerful first-person narratives of the suffering that can result from medical errors. Family members’ frustration with the lack of disclosure, minimal empathy from health care providers, and little acknowledgement of individual accountability is palpable. Subsequent chapters describe the institutional and cultural forces within the health care system that allow medical errors to occur and at the same time discourage reporting. Some chapters focus on underlying ethical principles or values as they pertain to policy reforms while others describe the implementation of values-based patient safety interventions. Nancy Berlinger’s discussion of the healing power of forgiveness, for both victims and health care professionals, is a particularly interesting topic not often discussed in the patient safety literature. The role of forgiveness brings into sharp relief the dynamic tension between individual and organizational accountability. Victims and their families need the individual acknowledgment that something went very wrong. Family members describe how difficult it is to get answers and point to the litigation process as the only avenue to the information that they needed to hear about the mistake that injured their loved one. Clinicians and analysts, on the other hand, describe the complex chain of events that contribute to most medical errors. In their eyes, individual accountability leaves the last person to touch the process “responsible” for any error. Individual accountability promotes the “shame and blame” environment and stymies efforts to truly improve care. How then to reconcile this dilemma? Unfortunately the essays raise many more interesting questions than they answer. The ethical limitations of moving from individual to institutional accountability are explored in several of the essays. Will individual providers absolve themselves from a responsibility to improve care? Is there reason to believe that organizations are inherently more ethical than individuals? The final chapters consider alternative legal options for compensating victims. Offering a unique perspective, this section of the book does not review the empirical evidence for or against tort liability but instead addresses tort reform from an ethical framework. All three authors argue that tort liability fails as an ethical compensation mechanism or deterrence mechanism, and its adversarial nature makes it difficult to turn errors into improvement. The implications of expanding mediation or a “no-fault” program are discussed. Again, the ethical implications of trading justice for one in return for the greater good of others become explicit. Accountability is a useful resource for readers interested in using an ethical framework to review general patient safety topics. The chapters are uneven and don’t make a coherent whole, which is not surprising given the diverse group of authors, topics, and perspectives that are represented. The book would have benefited from a concluding chapter to pull together the common threads and highlight conflicting perspectives. Most readers will be interested in selected essays rather than the book as a whole. The chapters are well referenced, though, so the interested reader is able to explore particular issues in more depth.

Journal

JAMAAmerican Medical Association

Published: Feb 23, 2005

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