CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
Better settlement outcomes can also be attributed to the development and teaching of the art of appropriate disclosure methods, which are based on the science of effective negotiation and conflict resolution. The method calls for sensitivity to the setting and the participants, and, most important, to the oral communications employed. Physicians need to listen closely to patients and families during the post-incident encounter, should not hesitate to show sympathy, and should understand the difference between an apology and an admission of liability. Saying “sorry” can go a long way. Careful speech and thoughtful listening are key to achieving satisfactory resolution of untoward events.
The best medicine, of course, is to prevent error. The College sponsored a Virtual Management College series on medical error earlier this year, which addressed systems-based approaches to counter human fallibility. Speakers explained the rationale for a culture centered on collective responsibility for patient safety, and they challenged conventional “blame and shame” thinking. Human fallibility is a given, they explained, but other enterprises have demonstrated that good systems can minimize mistakes and prevent oversights. Errors are consequences, not causes, said Lee H. Hilborne, MD, MPH, in his presentation for the first workshop on Feb. 12. We can engineer safety into the system, Ronald L. Sirota, MD, declared at the second VMC a month later. We can create protective systems as well as productive systems.
The College will sponsor a third program on errors in surgical pathology at the U.S. and Canadian Academy of Pathology meeting on March 3, 2003.
Fears about disclosing errors in care are rooted in fear of legal action, a concern that is being addressed by a bipartisan bill now before Congress. The Patient Safety and Quality Improvement Act, introduced in June, would create a medical errors reporting system made up of independent patient safety organizations that would analyze reports of untoward events and give feedback on how to fix problems. Information reported voluntarily for quality improvement and patient safety purposes would be held privileged and confidential.
The House version of the bill, sponsored by Rep. Nancy Johnson (R-Conn.), includes an excellent section on informatics. This version would create a medical information technology advisory board to advise the secretary of Health and Human Services on the best practices in medical information technology and methods to implement them. This legislation recognizes, as does the IOM, that greater attention to information technology can eliminate much of the medical error that is inherent in the system. Crossing the Quality Chasm calls for eliminating most handwritten clinical data by the end of the decade. This clear commitment to modern medical informatics is the way to go.
As pathologists, we work with a cross-section of specialists. Being dedicated to the clinical laboratory, we are comfortable with systems approaches, at home with quality assurance and quality improvement mechanisms, and appreciate the value of sound data analysis. As respected leaders in medical quality management, we are ideally prepared to take the lead in shaping a new culture of collective responsibility for quality in our hospitals. Continuous quality improvement in patient care and the application of top-quality laboratory informatics have been the hallmarks of our specialty and drivers for many of the CAP’s activities, including such premier services as Q-Probes, Surveys, and SNOMED, the universal vocabulary for medicine. Suddenly, our longtime ideals have become a necessity for all of medicine.
The need to develop efficient communication systems, methods for error analysis, and systems adjustments are all proper places in which our long-honed skills can be used effectively. Let us put our knowledge to work for the common good.