Paul Bartels & Jan Mainz Patient Safety - DK 2004 Helsinki ENQual Workshop 2 April 2nd 2004

Paul Bartels & Jan Mainz Patient Safety – DK Law of Doctors practice of medicine (Revised 2000) 1987Law of Patient Complaints Council (Revised 2003)

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Definitions of : -3 degrees of culpability -Surveillance, judgement and punitive measures Against doctors and nurses involved in adverse events with patient injury or complaints

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Protection of society ! Elimination of bad apples ! Power to the National Health Board ! Judgments of health-professionals by a council of peers, lay people chaired by a judge !

Paul Bartels & Jan Mainz Patient Safety – DK Law of patient insurance (rev. 2003) No-fault compensation after iatrogenic injury : - due to medical practice below standard - due to unusually severe complications - due to technology malfunction - If injury could have been avoided by using an alternative method

Paul Bartels & Jan Mainz Patient Safety – DK – after the IOM-report : ´’5-10 % of all US patients are injured by adverse events’ We don’t have these problems in Denmark ? – or do we? National Pilot Study of Adverse Events

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Retrospective – based on evaluation of 1100 medical records. 4 counties : Metropolitan/ rural, University/district/local hospitals Results: 114 records with adverse events and injury 40 % preventable 7 deaths Conlusion : We have a problem

Paul Bartels & Jan Mainz Patient Safety – DK : Local initiatives: Copenhagen Hospital Corporation unit of patient safety: Translates JCHAO and VHA methods to DK New Tools Local county strategies and experiments: Patient perspectives, Audit, Human factors Preparation of political decisions

Paul Bartels & Jan Mainz Patient Safety – DK Danish Society for Patient Safety (Patient Safety Foundation): Hospital owners, Danish Medical Ass., Ass of Nurses, Drug- and Medical Device Industry associations, Apothecaries association

Paul Bartels & Jan Mainz Patient Safety – DK 2004 DSPS cont. Scientific meetings Development of educational material Courses in patient safety Newsletter and homepage (Warning and advice) Establishing of local and internatational networks

Paul Bartels & Jan Mainz Patient Safety – DK National Survey: Attitudes of Healthcare-professionals to reporting, analysis and learning from adverse events. Confidential – not anonymous Fear of Health Authorities, management,professional peers: Patient Safety also requires change of culture

Paul Bartels & Jan Mainz Patient Safety – DK Act of Patient Safety: WE MARGRETHE THE SECOND by the grace of God Queen of Denmark, hereby make known The objective of the Act is to improve patient safety within the Danish health care system. The Act shall apply to the reporting of advers events occuring with the treatment of patients…. (

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Obligations according to the Act: - All healthcare workers: Report A.E. -Hospital owners: Systems for receiving analyzing and learning from A.E. reports -National Health Board: Web-based Confidential IT-system. National Database of A.E. + analyses.

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Act (cnt.) Authorities: Informations from the reporting system are absolutely confidential and cannot be used as evidence in court, evidence for action from health authorities against professionals or diciplinary actions from the hospital owner.

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Act. (Cnt) Only in-hospital events (primary care in 2006) Medication events Events related to invasive procedures Serious events

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Implementation of a safety organisation Clinical level : Medical risk coordinator in every department: Senior doctor/nurse Risk managers (Healthcare profs) at every hospital and/or county.

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Medical risk coordinator : Knowledge – motivation of peers – assesment of A. E. Risk Manager: Analysis (Root Cause, Audit, Data from other sources) Administrations of the reporting system

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Management: Departmental : Main responsibility for conducting analysis and drawing conclusions (change of practice) Finding ressources – TIME ! Establish non-blame culture

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Management – Hospital /County Ensure the presence of proper methods, dedicated staff and relevant training. Nonblaming Culture (It can be learned – even by medical directors and senior surgeons)

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Training: Heads of departments (all) 1. day (Overview – the law – the patient perspective – human ressource management of staff involved in A.E.)

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Medical risk coordinator Training: Two days: As head of departments plus training in assesment and root-cause analysis Human factor analysis

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Risk Manager Training: 14 days National level: In- depth training in assesment and root-cause analysis Supervision of actual case-work Human factor analysis prospective risk-assesment in planning of clinical pathways

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Act – implementation: status after 3 months Århus County /DK -75 / 500 reports -140/ ? Clinicians trained - 4/ 43 Risk managers in training -Official (politically approved) policy promoting no-blame culture -Publications and policies spread all over the county

Paul Bartels & Jan Mainz Patient Safety – DK 2004 Future Needs Sound evidence based surveillance tools – real indicators. DO PATIENTS GET VALUE FOR THE MONEY AND EFFORTS SPENT HERE ?