by Deborah LaValley, BSN, RN, CPHQ, Senior Loss Prevention Specialist, CRICOIRMF
No one discipline (physician, nurse, technician, or patient, etc.) can possibly maintain total awareness of a patient's care needs in order to avoid all adverse events. Good care truly needs to be a team effort and, when possible, the patient needs to be an active part of the team. To that end, when information about a patient is being exchanged among clinicians, the patient needs to listen and be heard.
Within the last few years, the health care industry has also begun to encourage patients to take a more active role in their health care by reinforcing their need to ask questions and speak up when they have concerns. In March 2002, the Joint Commission and the Centers for Medicare and Medicaid Services (CMS), together, launched a national program to urge patients to take an active role in preventing health care errors. When patients and their families become members of the health care team, they also become a party to many of the information handoffs involved in their care and, in effect, safeguards in the system: a reminder to caregivers to recheck or validate that the right thing is being done.'
Before the patient's role in handoffs can truly be successful, the culture of health care must change. Health care professionals must believe that patients have an important role in reducing mistakes.' For example, the Council on Graduate Medical Education (COOME) and the National Advisory Council on Nurse Education and Practice issued a joint report stating that physicians and nurses "will have to adjust their own practice approaches to encourage patients to become educated and to participate in their own health care.'
Time and patience may influence the quality of a practitioner's response to a patient's questions, concerns, and feedback. The practitioner's ability to listen and provide explanations and answers in a way that the patient, or his/her family, can understand frequently falls short. Many physicians are unaware that their communications with patients are often too cryptic or too complex.'
Patients want to be listened to and respected for their opinions. They are frequently asked to speak up when they have a concern, but may not have been given enough information to understand what is happening to them. Patients cannot effectively assist in the prevention of adverse events without knowing their health status or understanding the health care processes involved in their diagnosis and treatment.'
A patient's ability to effectively communicate with caregivers can be further complicated by his or her:
- health status;
- preoccupation with issues at home, work, finances;
- fear of offending their health care providers or being viewed as too demanding;
- denial that anything bad could happen to them;
- expectation that the people caring for them hold this responsibility;
- education, literacy, and language; and
- cultural factors related to manners and authority'
Clinicians encouraging patient participation in information handoffs might consider the following:
- use your position: patients will, generally, respond to a respected caregiver's invitation to help and ask questions;
- provide interpreter services as needed;
- provide an adequate setting and time for the patient to share information and ask questions;
- avoid appearing defensive;
- explain what you are doing, why, and what the patient should expect;
- confirm what the patient has conveyed to you, or that you have answered the question he or she asked;
- ask the patient to explain back to you important information, clarify any misunderstandings.'
The belief that health care providers should always have sufficient knowledge and skills to prevent mistakes—to function as the sole guardians of safety—remains pervasive, even if it is unrealistic. The expectation that all patients will be active participants in their care is equally naïve. Both, however, are goals worth pursuing.
Notes and References
1 5path PI, Nash DB. Partnering with Patients to Reduce Medical Errors. Chicago: American Hospital Association, 2004
2 See: "How Literacy and Communication Initiatives Improve Patient Safety." Volume 8, Number 3, 2005. IhttpArwww.npsi.orgrdownloadriocus2005VANo3.pdf