Patient safety: res publica non gratainthe majority of Eastern Europe

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Patient safety res publica non grata in the
majority of Eastern Europe
BARBARA KUTRYBA HALINA WASIKOWSKA
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PATIENT SAFETY?
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Patient safety is an issue in the developed
countries and it is not in the less developed
states (1)

• Stage of pre-awareness (Lucian Leape)
• Culture of secrecy, professional protectionism,
  defensiveness,deference to authority, hierarchy,
  victimization
• No public attention, no policy attention (quality
  is decency)
• Unacceptable notion of unsafe healthcare system

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Patient safety is an issue in the developed
countries and it is not in the less developed
states (2)

• Reluctance to address patient safety corruption,
  access, political decision making, waste already
  ruin reputation of healtcare systems
• Patient safety starts with entering a system...
• Healthcare professionals multiple reforms result
  in frustration, disempowerement unwillingness
  to change
• Media coverage the news basis no healthcare
  industry airplane crashes as levers for change

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Poland number of medical errors unknown
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Poland what do we know?

• - tort legislation for malpractice claims
• - hospitals are underinsured
• - private insurers quit healthcare insurance
• market (e.g.TU Compensa S.A)
• - number of malpractice claims unknown
• - no data on the amount of claim
• Hospital infections, medical errors,inappropriate
  equipment maintenance

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Poland what do we know?

• - Lack of adequate patient care on weekends
  and/or holidays
• - Sudden, unexpected patient death after a simple
  surgery
• - Heavy complications, not anticipated by a
  patient nor patients family
• - Lack of effective doctor-patient communication
• Prof.
  B.Swiatek, Dpt. of Forensic
• Medicine, Medical Academy,
  Wroclaw, 1994

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• The deduced rate of participation
• in adverse events
• 78,5

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Why adverse events?

• Excessive workload (83)
• Lack of motivation (nurses 55doctors 41)
• Out-dated/incomplete/un-updated procedures (53)
• Inadequate education/training (39)
• Lack of tradition in communication about errors
  (40)
• Lack of support from experienced peers (40)

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Patient Safety Will Be ImprovedIf a Reporting
System Is Introduced
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Patient empowerement

• Patriarchal and paternalistic attitude of
  Corporate
• (Supreme Medical Council)
• Inadequate patient education
• Patient rights well protected but not well
  observed e.g.access
• to medical records

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Inform the Patient About the Incident
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Why disclosure is not everyday practice?

• Patient who learns about harm would put in a
  claim
• Uncomfortable contact with patient family
• Hospital/ward gains derogatory status
• Organizational helplessness
• Media coverage/victimization/public disgrace
• Stigmatization of colleagues

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Gap between declaration and praxis a case study

• Rehabilitation Hospital 560 beds
• Number of hospitalizations - 8134
• Quality awards ISO 9001/2000, ISO 14 000, Health
  Promoting Hospital center of QI education
• Accreditation certificate since 1999.
• Last survey June 2005
• Mortality rate 2004 20
• Deaths due to elopement in 2004 - 2

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• A discord
• Non-compliance to patient deaths analysis,
• especially the park deaths, resulted in
• formal protest from the hospital management
• doctors corporate communication with
• Regional Chamber of Physicians discussion
• at Accreditation Councilpersonal disappointment,
• bitterness and mistrust

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