The 2007 JCAHO Patient Safety Goals: Patient Involvement

Patient Safety Quality Monthly

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June 15, 2006

Dear Colleague,

The JCAHO recently announced the new 2007 patient safety goals and requirements. As usual they represent a mixed bag of changes that are useful and opportunities that were missed from the proposed options. I will comment on the missed opportunities, in particular, Rapid Response Teams, next month. This month I would like to discuss Goal 13: Encourage patients' active involvement in their own care as a patient safety strategy.

In health care, we have long had an approach-avoidance relationship with our patients regarding their involvement in their own care. In the outpatient setting, we have approach patients with a paradigm of self reliance and personal accountability. We get frustrated when patients do show initiative and don't comply with sometimes complex and confusing care requirements. And we bemoan the fact that patients don't always tell us about all their symptoms so we can more quickly diagnosis and treat them.

But in the inpatient setting, we follow a paradigm of the sick and helpless. We are here to care for you. Do as you are told and we will make you better. Yet we all have stories about when our loved ones are in the hospital how things didn't go as planned and, if we hadn't known the system, disaster may have occurred.

The truth is, often times when it comes to patient involvement, as Pogo once said, "We have met the enemy and they are us". We give out messages, usually unintended, that discourage proactive communication by patients. Yes, some patients and their families can push through the system through personal perseverance. But to be a high reliability organization, we cannot rely on personality traits to assure communication. We need to implement systematic methods and behaviors the create a culture of open communication be the patients and caregivers.

The requirement for Goal 13 is to define and communicate the means for patients and their families to report concerns about safety and encourage them to do so. This has two parts. The first part is the system design; the second part is the learned behaviors that make the system real.

Designing a system for patient reporting isn't very hard. Most hospitals have patient compliant systems in place that will probably meet this standard. But to go beyond mere standard compliance, the reporting systems need to improve how they handle the subtle concerns that later turn into something larger.

The real change will be how individual care givers are trained to encourage and promote the use of these systems. Part of that change is in the up-front attitude that let's patients know that their input is not just tolerated for regulatory compliance, but is embraced because it is vital to their successful outcome. And part of that change is in the response to the patient concern that reinforces that value of embracing patient involvement through timely and helpful follow-up.

Although Goal 13 sounds like a communication issue, the real goal, and the real gold, is to develop a partnering relationship between caregivers, patients that our systems of care achieving the best outcomes.

Regards,

Bob Marder, MD
Practice Director, Quality and Patient Safety
The Greeley Company

For more information on our Patient Safety and Quality consulting services, click here or contact Christine Beringer by e-mail, cberinger@greeley.com, or by phone at 888/749-3054, ext. 3174.

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