The Change of Perception Towards our Healthcare Journey:
TakeCharge Campaign
27th August 2021.
Ngadiuba, Alina
Pulse Center for
Patient Safety Education and Advocacy in partnership with Health Strategies
Reform
MEDICAL ERROR IN THE HEALTHCARE SYSTEM- “TAKE CHARGE CAMPAIGN”.
Communication
between a healthcare physician and their respective patients plays a
significant role in developing trust in a doctor-patient relationship. This is
considered a leading factor in delivering proper healthcare services to
patients. Communication involves the exchange of information and negotiation of
mutual expectations between the doctor and the patient; a positive approach
from a healthcare practitioner can increase the adherence of a patient. The
outcome of a patient’s care is strongly associated with the communication
during discussion or taking notes of medical history in consideration of a
management plan. Furthermore, good communication behavior among doctors and
their patients is related with the decrease in malpractice claims, and the
patterns of communication between patient and physician has been associated
with the satisfaction of medical visits. The explanations doctors provide to
patients and the patient’s understanding to those explanations have shown to
have an impact on the patient’s satisfaction and adherence to medical
administrations (Zolaly, 2012).
Patient
satisfaction has gained relevance in the healthcare system across the world.
Studies have indicated that patient’s perception towards the healthcare system
has been accepted as valid, significant, and standard indicators for improving
the quality of healthcare services. Nonetheless, patients often fail to discuss
their respective issues and anxieties with their healthcare practitioners when
they are dissatisfied with the attitude of a doctor; hence, doctors lack
awareness on the state of satisfaction of a patient with the healthcare
consultation (Covinsky, Bates, Davis, & Delbanco, 1996).
Research
studies have shown that lack of communication between doctors and their
patients have are long existed problems in the medical subculture within the
healthcare system (André Busato, Andreas Dönges, Sylvia Herren, Marcel Widmer,
& Florica Marian, 2006). For instance, in the current healthcare practice
environment, doctors are faced with several demands that are require time
resources; increase in administrative requirements for the delivery of
healthcare services such as service and authorizing requests and utilizing the
process of reviews which affects the time allocated to patients. In 1995, the
Commonwealth Fund Survey indicated that 41% of physicians reported a decline in
the time spent with patients, while 43% stated that there is a decrease on the
amount of time spent with their respective colleagues. Due to the changes in
social and demographics of the healthcare workforce, most physicians have other
responsibilities that reduce the time spent on patients. These factors have
been considered as a crucial issue in establishing a firm doctor-patient
relationship (Dugdale, Epstein, & Pantilat, 1999).
In
several scientific concepts, participation has different terms; In sociology, participation is defined as the means of
sharing a beneficial mutual interest or participating in a group, while in
political sciences, participation refers to: people facing the same problem with similar feelings, they careless
about the problems and may consider their actions irrelevant, and/or due to
lack of knowledge or awareness, people may consider their participation
inadequate and may restrain from participating. Several studies illustrate that the “focus of
interest has been on participation of patients in care and treatment decision
making process, using such terminologies as involvement, collaboration and
partnership of patients, clients, consumers and users”. There are different
concepts on patient participation; one view considers the participation of a patient in the decision making of treatment
for their respect health issues, while other view indicates that patient
participation means the “involvement of patient in disclosing relevant
information, feelings and accepting the provided instructions of doctors and
nurses”(Vahdat, Hamzehgardeshi, Hessam, & Hamzehgardeshi, 2014).
The participation of patients in the
decision making of healthcare delivery and treatment is not a new area of
focus; however, it has currently become a political necessity in different
countries and healthcare management worldwide (Vahdat et al., 2014). It is
known that the essential factor to improve the quality of healthcare services
for patients around the world is to encourage patients to actively participate
in their healthcare. According to the UK’s National Patient Safety Agency
(NPSA), patients can play a significant role in reducing the incident rate of
unintended injuries within the healthcare system. For instance, patients can
contribute to preventing medication error and monitoring any cases of adverse
events within the healthcare system (Davis, Jacklin, Sevdalis, & Vincent,
2007).
Studies show that “the causes of diagnostic
misadventures include problems that patients could potentially mitigate under
some circumstances”.. In a retrospective study that involved patients who
experienced diagnostics delay for colorectal cancer in America, an estimate of
one-third had an average of 5.3 diagnostic process breakdown which includes
lack of notifying the possibility of missing a diagnostic test appointment.
From 587 patients who were diagnosed with lung cancer, about 44% of patients
missed their appointments for diagnosis. While each patient is faced with their
respective unique health challenge, patients are most likely to find barriers
to participate in the journey of their diagnosis, especially when there is a
feasible opportunity. Patients persistently find it challenging to communicate
with their physicians; hence, creating an imbalance of power between the
healthcare practitioner and patient (McDonald, Bryce, & Graber, 2013). Even
though there has been an emphasis on the importance of patient’s involvement in
their healthcare, evidence show that there are specific impediment that result
to lack of effort to improve doctor-patient relationship. In a qualitative
research study, a focus group of primary care patients indicated a hierarchical
association with their respective doctors, defined by less than honest
discussions and poor exchange of information. Furthermore, patients restrained
from asking their physicians questions during their visits due to the fear of
“second guessing” or the fear of being wrongly perceived by their physicians
although they had an above average educational level and sought for external
sources, either to clarify or make sense of their conversation with their
doctors. In other cases, patients and their families are faced with several
options without sufficient supervision from their doctor or coordination
(Frosch, May, Rendle, Tietbohl, & Elwyn, 2012).
“The consumer model” and the “metaphor of
the marketplace” are currently are applied in everyday life activities. They
provide information on the different fields of the healthcare such as the
opportunity to develop new and various relationship between the physician and
the patient. Patients have technical competence expectations in their doctors,
the availability, and the accessibility to healthcare (Lings et al., 2003).
Over the last decades, the occurrence of
Healthcare Associated Infections (HAIs) has been acknowledged in the
literature; it continues to increase in an alarming rate across the world. HAIs
was originally referred to the infections that are related with the hospital
admission in an acute-care unit (previously known as Nosocomial Infection), but
recently, the term is applied to infections contracted during a continuous
healthcare delivery (such as long-term care, home care and ambulatory care)
among patients. These unforeseen infections can occur during the course of a
patient’s healthcare treatment that results in to a significant increase in
patient illness and deaths (morbidity and mortality rate); prolonged hospitalization;
and increase of diagnostic procedures and therapeutic interventions, which
incurs additional cost to patients with chronic diseases or upon the healthcare
system. HAIs are considered preventable scenarios with undesirable impact on
the healthcare deliver; quality of care indicator; an adverse event; and
patient safety problems (Collins, 1991).
Healthcare Associated Infections (HAIs)
is proven to be the most common cause of morbidity and mortality rate in the
United States; they are considered the most frequent adverse events that occurs
within the healthcare system. There is current emphasis on the HAIs as a
patient safety hazard in the healthcare system and a public health issue that
is in need for “Systematic HAI Surveillance”. Research studies have shown that
in March 2006, 7 states in the United States have implemented an obligated
reporting for HAIs in hospitals, while other states are in consideration of
mandating similar legislative. According to the Centers for Disease Control and
Prevention (CDC), National Nosocomial Infections Surveillance (NNIS) system, a
study conducted in 1970 involved 62 participating hospitals, which eventually
extended to over 300 acute care hospitals in 42 states by 2000 (Klevens et al.,
2007). A survey which was carried out in 183 US hospitals of 11,282 patients
had reported that approximately 4% of patients had at least 1 HAI with the
often occurrence of microorganism called Clostridium Difficile. Other related
infections include Surgical Site Infection (SSI), Pneumonia, and
Gastrointestinal Infections. Another study which was conducted 2 years
earlier by the same group discovered that 6% (51) of patients had experienced
HAI with the top 75.8% of obtaining SSIs, Urinary Tract Infection (UTI),
Pneumonia, and Blood Stream Infection (Haque, Sartelli, McKimm, & Bakar,
2018).
Medical error is defined as a
preventable, yet an adverse effect of medical care provided to patients even
though it may or may not be evident. Adverse drug events; improper transfusion;
misdiagnosis; under/over treatment; surgical injuries; wrong site surgery; suicides; restraint-related injuries or death; falls; burns; pressure ulcers and
mistaken patient identities are the most common medical error in the healthcare
system. The increase of error rates that have adverse health outcomes normally
occur in Intensive Care Units (ICU), Operating Rooms (OR), and Emergency
Departments (ER). Medical
errors can also be related to aging, new procedures, healthcare urgency and the
severity of the medical condition. However, according to the 1999 IOM Report,
most of the medical errors are results of faulty healthcare system; processes
and conditions that could result to preventable mistakes, and not merely the
carelessness of a person or the actions taken by a particular group (Niki
Carver; Vikas Gupta; John E. Hipskind., 2020).
After the 2016 BMJ publication that
“claims medical error should be considered the third leading cause of death in
the USA”, there have been an increase of debate on the true incidence of death
rate due to medical error. Studies indicate an annual estimate of 25, 0000
deaths due to medical error. An investigation carried out in the United Kingdom
looked at 70 different studies which included 337,025 patients from general
hospital, 47,148 of the patients suffered from injuries with 25,977 (55%)
reported preventable injuries (SKEPTICAL SCALPEL, 2020). There has been a
recent rise of medical errors in the USA; over 400,000 deaths have occurred
within the last years which differs by states. The United States of America has
the highest record of medical errors as compared to other developed countries.
The most common medical error in USA is “surgical error”, which has been
attributed as most preventable because surgical error is directly associated
with patient safety(Canalichio, Berrondo, & Lendvay, 2020) .
TAKE CHARGE CAMPAIGN:
The
“Take Charge” Campaign aims at preparing people to become better prepared as patients
by changing their perspection towards the involvement of their healthcare using
5 steps.
STEP 3:Prepare for Doctor Visits / Make A List of Questions
OBJECTIVES:
To educate people on the importance of asking their healthcare practitioner relevant questions.
The TakeCharge campaign is a health
campaign that focuses on helping patients and their families to understand
their responsibilities in managing their healthcare as patients (if that should
ever be the case). The campaign begun in the year of 2019, on the month of
September. The campaign is non-funded campaign that involves 5 steps to “Safer
Healthcare” to educate patients and their families to become active members of
their healthcare team; to inform them on how to take charge of their healthcare
decisions before the strike of any crisis.
The TakeCharge Campaign offers a
different approach to reach the general public on the various ways of improving
their healthcare before they become actual patients within the healthcare
system. “This is not about HEALTH, but HEALTHCARE, the journey
to better health”.
The 5 Steps to Safer
Health Care!
1. Understand & Complete Your Advance Directives
Specifically, the healthcare proxy
form or choosing a surrogate decision maker. According to the Mayo Clinic,
“Advance directives guide choices for doctors and caregivers if you're
terminally ill, seriously injured, in a coma, in the late stages of dementia or
near the end of life.” Even temporarily as we have seen in recent months that
people with COVID on a ventilator can not speak for themselves. Children leaving for college, at 18 years old
may need a parent or other person. By
choosing early to have a surrogate decisions maker, and the conversation about
their preferred care wishes, people who cannot speak for themselves can be
assured the care they wish for will be carried out.
2. Keep a Record of Your Medical History &
Current Medications
Just as a resumé helps
an employer understand your suitability for a job, a personal medical
history helps a clinician understand the whole picture of you as a
patient. That is especially true when you are seeing a healthcare provider for
the first time, or when you see multiple providers. Updated lists by the
patient can help to ensure information is correct.
3. Prepare for Doctor
Visits / Make A List of Questions
Hospitals and other therapy centers can
present a whole galaxy of unknown situations and unfamiliar demands. Make a
list, ask family to add questions, and bring it with you to the hospital
intake, along with pen and paper to note down the answers. Included should be
any new symptoms, new medications and clinicians. Being prepared can help ensure questions are
answered and time is used appropriately.
Before your next medical appointment, prepare your questions
4. Prevent Infections / Ask Caregivers to Wash Their Hands
One of the most basic
yet most effective ways to prevent infections is for everyone — doctors,
therapists, nurses, friends, and family — to wash their hands before touching the
patient. But medical staff are busy and under pressure: sometimes they forget.
5. Use an Advocate / Be an Advocate for Others
Everyone getting medical
treatment should have someone to support them, to help raise questions, take
notes, enhance communication with medical staff and make sure they are
receiving patient-centered care.
This person is called a “patient advocate”. Such an advocate can help
organize support from others, help review treatment options,
and generally support a patient’s needs throughout their care and
treatment. And the sicker, less “on top of things” the patient is, the
more that advocate is needed. The advocate can help focus on the 5 Steps for
the patient.
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(2020). Simulation Training in
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It has been proven to be problematic to have access to
hospital and emergency services in a more distant location in Canada.
Geographical distance can result to poor access to healthcare services