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The first real step towards safer care?
[ by Niall Hunter, Editor www.irishhealth.com]
Health Minister James Reilly, launching HIQA's new National Standards for Safer Better Healthcare, stressed, quite correctly, that if these new rules do not improve the patient's journey, they will count for nothing.
He also stressed the importance of improving governance and management standards in hospitals to ensure that patient safety is at the core of all healthcare activity.
For once, this may not be merely a pious platitude, because these new safety rules will provide a 'stick' and not just a 'carrot' approach in ensuring that patients are treated properly and safety in healthcare settings.
The new standards will provide the basis, eventually, for a licensing system that will ensure that only healthcare facilities that comply with the safety standards will be given a licence to operate, and those who do not continue to meet the standards could face losing their licences.
We can only hope that this long-promised legislation is enacted as soon as possible. For too long we have been depending on 'post-scandal policy' to prop up an ad-hoc approach to the promotion of safer healthcare in Ireland.
Of course, we can accept that most healthcare provision in Ireland is of good quality and is usually safe.
But simply repeating this mantra, as has so often been done, in the wake of the latest patient harm scandal is no substitute for proper uniform standards that will ensure insofar as is possible that patients will not come any unnecessary harm in healthcare wherever they are treated.
In the absence of proper monitoring, inspection and licensing of healthcare facilities, post-scandal reassurances, or 'healthcare by helpline' policies, are simply not good enough.
After many years of treatment scandals in areas such as obstetrics, cancer, x-rays and ED care, we have become used to the drill by now- 'any patients with concerns are advised to ring this number'; 'a review is being carried out'; 'systems to blame' ; 'learning from mistakes'; 'new guidelines to ensure this doesn't happen again...'we need to move on from this...'
Yes, to turning on our radios one morning soon afterwards and hearing about another healthcare scandal.
And, of course, we have had many review reports which, despite their overall thoroughness, often (sometimes one suspects at the behest of our learned friends) point no fingers at who might have been to blame or clues as to the consequences for those who may have contributed to the sins of omission, negligence or inefficiency which led to patient harm.
It is obviously not a good idea to undertake witch-hunts or scapegoating in the wake of major adverse incidents., However, in a situation where it is only the unfortunate patient who tends to suffer adverse consequences from treatment scandals, are staff, and systems, ever going to really learn from their mistakes?
In other words, if actions, or lack of actions, often do not have direct consequences for those governing, managing and providing a service when things go very wrong, we cannot hope to give any sort of reasonable guarantee of patient safety.
This, hopefully, will change with the implementation of the new HIQA safe care guidelines and the promised healthcare facility licensing system.
This system may give us a fine balance between accountabillty, 'learning', and ultimately, consequences, to ensure that those running and working in healthcare settings really do try to act in the patient's interest at all times.
Samuel Johnson said: 'when a man knows he is to be hanged in a fortnight, it concentrates his mind wonderfully.'
If a hospital or healthcare facility, and those in charge of delivering services within it, knows it is in danger of losing its licence if it does not make necessary safety or quality improvements, this must surely act as the ultimate incentive to the institution getting its act together.
If a facility does lose its licence under the new system, then presumably its provisions will ensure that there are clear lines of accountability to identify those who fell down on the job.
But let's not be too optimistic that a brave new world of proper accountability for safe healthcare provision is upon us.
Firstly, there is the mindset issue.
A summary of some findings from the recent report on unsafe ED service provision at Tallaght Hospital may be appropriate here:
In December 2010, one month after the Hayes review on the unreported x-ray scandal was published and Tallaght said it was acting on its findings, emergency medicine consultants informed the safety body about ongoing concerns regarding the management of risks to patients in the ED, particularly with regard to patients being treated on a corridor.
This unsafe practice continued at the hospital for a further eight months, until it was stopped on the orders of HIQA.
Now, it is perhaps a little unfair at this stage to single out Tallaght Hospital yet again when it comes to lessons to be learned from patient safety issues. Tallaght has recently implemented some welcome improvements.
However, it should be stated that two patients died as a result of being accommodated in unsafe facilities in an ED corridor at the hospital prior to these improvements being made.
But some of the governance and management issues which emerged in recent years at Tallaght could be found in other hospitals as well.
What the Tallaght scandals show us is a culture of poor learning and accountabiilty in the wake of deficiencies in how care is organised and delivered in our health system.
Another example of the need for mindset change comes from an article in late 2009 in the Clinical Indemnity Scheme newsletter. This is the State scheme that indemnifies hospitals against adverse incidents.
The article stated that while 'open disclosure' and good communication with the injured party after an adverse incident is welcome, 'open disclosure is not and should not be an admission of liability.'
It went on to say that those engaged in communication after an incident 'must not state or agree that the particular hospital/enterprise was liable for the harm caused to patient or was negligent.'
This advice, while well-meaning in administrative terms terms and perhaps legalistically prudent, would hold little comfort for people who have been at the wrong end of an adverse incident or medical error. One wonders indeed how this advice, proffered by a State body, would fit in with the new safety and licensing guidelines being implemented by the State.
Finally, there is the question of resources (isn't there always?). We are currently going through an unprecedented funding crisis in our health service. Do hospitals have the resources to ensure that patients will be treated safely at all times?
If hospitals are treating patients on chairs or even on the floors in emergency departments, thereby potentialy endangering these patients, how can they comply with safety rules if they simply do not have the beds to put these patients in and treat them more safely?
That said, the new HIQA guidelines mark an important step forward in the provision of a better standard standard of healthcare in Ireland.
|zebedee Posted: 18/07/2012 12:39|
This is more waffle, hype and meaningless red-tape which will keep more admin staff employed and of course some ridiculously highly paid Head or CEO of a new Licensing body with a team of highly paid colleagues (jobs for the boys) to back him/her up. Then of course, they'll need to employ outside consultants to advise them on how to do it. It'll simply detract from resources into frontline services.
My understadning and belief is that HIQA still haven't resumed hospital inspections for hygiene, despite their assurances many months ago, and this is supposed to be a primary function of HIQA! So how on earth is licensing of hospitals going to be done? And let's be serious, are we really going to see any closed or losing their license? If we were ever to see this happen, then there's a couple which we already know would've been shut down already. It simply wouldn't happen and we all know it!
Forget all this admin bull and concentrate on frontline services for heaven's sake. As for accountability and imporvement in practice.... How about HIQA inspect hospitals as per their remit and when a poor rating is achieved, heads roll at management level for that hospital. No big pay-offs, simply sacked for incompetence and blacklisted so no other public job available to them? That would concentrate their minds I'm sure.
But hey, accountability in the HSE &/or Dept of Health? Has anyone in HIQA paid any consequences for their not carrying out a primary remit? Of course not, and so it goes on!
Political leadership and public sector leadership in this country is abismal and full of too many under qualified, under experienced, pathetically incompetent, over paid individuals and a clear out in the Dept fo Health and HSE would be a great place to start.
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