Promoting Patient Safety: An Ethical Basis for Policy Deliberation

The Hastings Center Report, September-October 2003 | Go to article overview

Promoting Patient Safety: An Ethical Basis for Policy Deliberation


AN OVERVIEW OF THE PROJECT

This is the final report of a two-year Hastings Center research project that was launched in response to the landmark 1999 report from the Institute of Medicine, To Err Is Human, and the extraordinary attention that policymakers at the federal, state, regulatory, and institutional levels are devoting to patient safety. It seeks to foster clearer and better discussion of the ethical concerns that are integral to the development and implementation of sound and effective policies to address the problem of medical error. It is intended for policymakers, patient safety advocates, health care administrators, clinicians, lawyers, ethicists, educators, and others involved in designing and maintaining safety policies and practices within health care institutions.

Among the topics discussed in the report:

* the values, principles, and perceived obligations underlying patient safety efforts;

* the historical and continuing tensions between "individual" and "system" accountability, between error "reporting" to oversight agencies and error "disclosure" to patients and families, and between aggregate safety improvement and the rights and welfare of individual patients;

* the practical implications for patient safety of defining "responsibility" retrospectively, as praise or blame for past events, or prospectively, as it relates to professional obligations and goals for the future;

* the shortcomings of tort liability as a means of building institutional cultures of safety, learning from error, supporting truth telling as a professional obligation, or adequately compensating patients and families, contrasted with alternative models of dispute resolution, including mediation and no-fault liability;

* the needs of patients, families, and clinicians affected by harmful errors and how these needs may be addressed within systems approaches to patient safety; and

* the potential conflicts between the protection of patient privacy required by the Health Insurance Portability and Accountability Act and efforts to use patient data for the purposes of safety improvement, and how these conflicts may be resolved.

Although this report is the work of the project's principal investigator, not a statement of consensus, it draws from the insights of the interdisciplinary group of experts convened by The Hastings Center to make sense of the complex phenomenon of patient safety reform. Working group members brought their experience as people who had suffered from devastating medical harms and as institutional leaders galvanized to reform by tragic events in their own health care institutions. They brought expertise as clinicians, chaplains, and risk managers working to deliver health care, confront its problems, and make it safer for patients. They brought familiarity with the systems thinking deployed in air traffic control and in the military. And they brought critical insight from medical history and sociology, economics, health care purchasing, health policy, law, philosophy, and religious studies.

The research project was made possible through a major grant from the Patrick and Catherine Weldon Donaghue Medical Research Foundation.

On the cover: Hospital, by Frank Moore, 1992. Oil on wood with frame and attachments. 49" x 58" overall. Private Collection, Italy. Courtesy Sperone Westwater, New York.

PROMOTING PATIENT SAFETY

AN ETHICAL BASIS FOR POLICY DELIBERATION

by Virginia A. Sharpe

Over the last three years, patient safety and the reduction of medical error have come to the fore as significant and pressing matters for policy reform in U.S. health care. In 2000, the Institute of Medicine's report, To Err Is Human: Building a Safer Health System presented the most comprehensive set of public policy recommendations on medical error and patient safety ever to have been proposed in the United States. …

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