13. international conference on health promoting hospitals, 2005 listening to the patient in solving...

13. International Conference on Health Promoting Hospitals, 2005

Listening to the Patient in Solving Problems Related to

Treatment Errors

Maria Hallman-Keiskoski M.Sc. in Health Education, Director of Nursing Central Finland Health Care DistrictE-mail: [email protected]


My Background

• Work as a head nurse with specialisation in health promotion (1991 )

• Experience of work as a patient rights advocate in addition to my regular job (1993-95; 1998-99)

• Finnish coordinator of the WHO Health Promoting Hospitals (HPH) network (2000 ->)


According to distinguished international studies, hospital care caused unexpectedproblems that were independent of the disease for about 10% of the patients.

About half of these problems could have been prevented!


A Study with the Patient Voice

Forster, Murff, Peterson et al. 2003

Sample: Telephone interview 2-5 weeks after

discharge, case summaries, N = 400

Results: 76 patients had adverse events after discharge (19%).

30% of them could have been prevented, and

32% had ameliorable adverse events.


The Need to Hear the Patient Voice

• Based on the literature, patients have an urgent need to openly discuss the incident.

• There is also a need to try to rebuild patient trust and give patients support for coping.


Case Study Design

1. Story by the patient (recorded)

2. Investigation (patient records + investigation report)Prof. Vincent et al. Investigation Protocol used

3. Feedback discussion (recorded)(patient, family member, people involved in care and/or experts, chief doctor as a chair, researcher)

4. Interviews with feedback discussion participants (recorded)


Study Question

• What do patients describe as treatment errors?


Voluntary Patients in Study Sample

In 2004, in a period of two months, a total of 2 162 patients received a handout on the study when arriving at the Emergency Room of Central Finland Central Hospital. Sixteen of them contacted the researcher, and three were chosen to the study sample.

”If your care at the emergency room involves aspects that you find undesirable

(e.g. difficulties in receiving care, vagueness in the examination or treatment,

waiting time) and you wish to settle them, please contact the researcher:”

Two additional patient cases from the year 2003, reported by staff, were also included in the study.


Diagnoses of the Patients

1. Ruptura musculus biceptis femoris l.sin 2. Fractura radii typica l.sin3. Fractura radii l.dx4. FA acuta/subacuta, Infarctus cerebri cum hemiparesis l.sin susp 5. Contractiones prematurales h 22+1

All of these cases were close-call situations.


Research Data• Transcribed recordings (N=5)

Story by patient / in 3 cases joint interview with a family member The patient was asked: ”What happened?”

- free description of eventsThe story continued for as long as the patient wanted

- from hospital/home to health centre, etc.

• Patient records (N=5)

Principal research method: content analysis


Treatment Errors Identified by the Patients

• Pain-related: insufficient anaesthesia,inadequate pain assessment, fear of being labelled as ”sickly”

• Shortcomings in basic care: insufficient infusion / nutrition; coldness

• Access to medical examinations: unnecessary delays, inaccurate situational diagnoses by physicians, problems in communication btw. emergency and x-ray department

• Functionality of the health care system: vague practices, problems in cooperation btw. units


Conclusions from Listening- Viewpoint of the Organization

• Listening provides valuable information about the experiences of individual patients, as well as about the functionality of the patient care chain.

• It can bring out organisational problems that are easily fixable.

• Listening is also an excellent tool in improving the quality of health care.

• It can help us understand the background of problems related to treatment errors.

• The results cannot be generalised, but we can learn from each individual case.


Conclusions from Listening- Viewpoint of the Patient

The patients• believed that the study promotes the solving of

organisational problems

• felt that the clarification process promotes coping

• were happy to receive proper medical information

• felt that it is better to solve things this way than to quarrel about the clinical incident


The future strength of Health Promoting Hospitals will be the systematic involvement of patients and their family members in the proactive anticipation and solving of treatment errors!

Conclusions from Listening- Viewpoint of the Researcher

13. international conference on health promoting hospitals, 2005 listening to the patient in solving...

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