Choice, Risk and Safety in the PCT context

Peter Mansell NPSA and Maria Dineen Consequence UK

Three questions

• How do we best harness choice to improve patient safety?

• What information is going to be most useful to inform safer choices?

• How can the NPSA complement the work of PCTs?

building a safer NHS for patients

• June 2001• establishment of National Patient

Safety Agency• government’s response to An

Organisation with a Memory• new national system for learning

from adverse events

Using choice to improve patient safety

Information for choice

What are some of the ways of engaging patients and the public about a safer choices?

Complaints RCAs Patient Surveys

Patient Forums Thematic reviews

• Aim: Choice between equally safe services; all services to be safe so that choice is on the basis of what’s best for you and your family.

• Challenge:“Currently, the NHS provides little or no information about quality that patients can use”King’s Fund, 2003

What does choice mean in the context of patient safety for a PCT?

It can mean…– Safer practice?

• improved access through being able to attend a Walk-In Centre.

– New risks? • choosing a generalist over a specialist surgeon

because of a preferred location.• More transition points between care providers.

Managing the new risks to patients from choice

• Involve patients in pre design work as well as traditional consultations.

• Risk assess: Pro-actively check whether new systems are safer; identify and quantify the risks.

• Learn lessons: patients already choose their optician and pharmacist.

• Electronic patient record.

Motivation to act

• Variation in quality exists and I may not get the best quality

• Failure to act will have a negative effect on health

• The harm that will result from failure to act: – is greater than any risk which is perceived to be

associated with the action;– is greater than the burden of time and effort involved in

taking action

OPM/The Nuffield Trust Involving People in Public Disclosure of Clinical Data

Discussion

• How can we ‘motivate’ people to be concerned about safety as an important element of choice without unduly undermining their confidence in the health care system?

What choice?

• Choice of time and place of service

• Choice of treatment

• Choice of provider

• What sort of information would be helpful to patients in making these choices?

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OrganisationA

OrganisationB

OrganisationC

OrganisationD

Which is the safer organisation?Reported incidents

per annum

Options for information for safer choices

• Comparative information on safety performance of healthcare organisations and services– how do we guard against unintended outcomes

• National patient safety goals/standards– can we assure a core level of safety

• Publishing data– what will be meaningful and not unduly erode trust?

• Other?

Supporting Choice

• What information about the safety of their services could PCTs provide?

• How might the NPSA help?

• Discussion