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ΠΟΙΟΤΗΤΑ ΣΤΗΝ ΟΡΘΚΗKΩΝΝΟΣ Δ ΘΕΟΛΟΓΟΥ
Orthopaedic Surgeryand Healthcare Quality
Konstantinos D Theologou MD DSc MSc Οrthopaedic Surgeon
QUALITY DEFINITION
A MEASURE OF EXCELLENCE A STATE OF BEING FREE FROM DEFECTS
DEFICIENCIES AND SIGNIFICANT VARIATIONS STRICT AND CONSISTENT COMMITMENT TO
CERTAIN STANDARDS THAT ACHIEVE UNIFORMITY OF A PRODUCT IN ORDER TO SATISFY SPECIFIC CUSTOMER OR USER REQUIREMENTS
httpwwwbusinessdictionarycomdefinitionqualityhtmlixzz2OvFer6mb
)
IS IT TIME TO TAKE A HARDER LOOK AT THE QALY
HOW MUCH A PERSONrsquoS HEALTH ACTUALLY COST
HOW DO YOU DETERMINE THAT
SHOULD HIGH-PRICED BIOLOGICS BE COVERED IF THEY ARE NOT COST-EFFECTIVE
Amanda Brower Biotechnol Healthc v5(3) Sep-Oct 2008
PUTTING A PRICE ON TREATMENT
HEALTH CARE IS CHANGING RAPIDLY
ALL THINGS TO ALL PEOPLE-IMPOSSIBLE
MAKE CHOICES
HOW MUCH LONGER THE TREATMENT WILL ALLOW YOU TO LIVE
HOW IT IMPROVES THE LIFE YOU HAVE
J Bone Joint Surg Am 2005 Jun87(6)1253-9
ORTHOPAEDIC COMMUNITY UNDERSTAND AND APPLY ECONOMIC EVALUATIONS
IT CAN BE USEFUL FOR SETTING PRIORITIES AND GUIDING RESEARCH
Cost-utility analyses in orthopaedic surgery
Harvard Center for Risk Analysis Harvard School
HEALTH SYSTEMS IN THE UNION - EFFORTS TO ENSURE IMPROVING QUALITY AND SAFETY STANDARDS TAKING INTO ACCOUNT
ADVANCES IN MEDICAL SCIENCE
GOOD MEDICAL PRACTICES
NEW HEALTH TECHNOLOGIES
DIRECTIVE 201124EU OF THE EUROPEAN PARLIAMENT
WHERE ARE YOU GOING
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
Orthopaedic Surgeryand Healthcare Quality
Konstantinos D Theologou MD DSc MSc Οrthopaedic Surgeon
QUALITY DEFINITION
A MEASURE OF EXCELLENCE A STATE OF BEING FREE FROM DEFECTS
DEFICIENCIES AND SIGNIFICANT VARIATIONS STRICT AND CONSISTENT COMMITMENT TO
CERTAIN STANDARDS THAT ACHIEVE UNIFORMITY OF A PRODUCT IN ORDER TO SATISFY SPECIFIC CUSTOMER OR USER REQUIREMENTS
httpwwwbusinessdictionarycomdefinitionqualityhtmlixzz2OvFer6mb
)
IS IT TIME TO TAKE A HARDER LOOK AT THE QALY
HOW MUCH A PERSONrsquoS HEALTH ACTUALLY COST
HOW DO YOU DETERMINE THAT
SHOULD HIGH-PRICED BIOLOGICS BE COVERED IF THEY ARE NOT COST-EFFECTIVE
Amanda Brower Biotechnol Healthc v5(3) Sep-Oct 2008
PUTTING A PRICE ON TREATMENT
HEALTH CARE IS CHANGING RAPIDLY
ALL THINGS TO ALL PEOPLE-IMPOSSIBLE
MAKE CHOICES
HOW MUCH LONGER THE TREATMENT WILL ALLOW YOU TO LIVE
HOW IT IMPROVES THE LIFE YOU HAVE
J Bone Joint Surg Am 2005 Jun87(6)1253-9
ORTHOPAEDIC COMMUNITY UNDERSTAND AND APPLY ECONOMIC EVALUATIONS
IT CAN BE USEFUL FOR SETTING PRIORITIES AND GUIDING RESEARCH
Cost-utility analyses in orthopaedic surgery
Harvard Center for Risk Analysis Harvard School
HEALTH SYSTEMS IN THE UNION - EFFORTS TO ENSURE IMPROVING QUALITY AND SAFETY STANDARDS TAKING INTO ACCOUNT
ADVANCES IN MEDICAL SCIENCE
GOOD MEDICAL PRACTICES
NEW HEALTH TECHNOLOGIES
DIRECTIVE 201124EU OF THE EUROPEAN PARLIAMENT
WHERE ARE YOU GOING
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
QUALITY DEFINITION
A MEASURE OF EXCELLENCE A STATE OF BEING FREE FROM DEFECTS
DEFICIENCIES AND SIGNIFICANT VARIATIONS STRICT AND CONSISTENT COMMITMENT TO
CERTAIN STANDARDS THAT ACHIEVE UNIFORMITY OF A PRODUCT IN ORDER TO SATISFY SPECIFIC CUSTOMER OR USER REQUIREMENTS
httpwwwbusinessdictionarycomdefinitionqualityhtmlixzz2OvFer6mb
)
IS IT TIME TO TAKE A HARDER LOOK AT THE QALY
HOW MUCH A PERSONrsquoS HEALTH ACTUALLY COST
HOW DO YOU DETERMINE THAT
SHOULD HIGH-PRICED BIOLOGICS BE COVERED IF THEY ARE NOT COST-EFFECTIVE
Amanda Brower Biotechnol Healthc v5(3) Sep-Oct 2008
PUTTING A PRICE ON TREATMENT
HEALTH CARE IS CHANGING RAPIDLY
ALL THINGS TO ALL PEOPLE-IMPOSSIBLE
MAKE CHOICES
HOW MUCH LONGER THE TREATMENT WILL ALLOW YOU TO LIVE
HOW IT IMPROVES THE LIFE YOU HAVE
J Bone Joint Surg Am 2005 Jun87(6)1253-9
ORTHOPAEDIC COMMUNITY UNDERSTAND AND APPLY ECONOMIC EVALUATIONS
IT CAN BE USEFUL FOR SETTING PRIORITIES AND GUIDING RESEARCH
Cost-utility analyses in orthopaedic surgery
Harvard Center for Risk Analysis Harvard School
HEALTH SYSTEMS IN THE UNION - EFFORTS TO ENSURE IMPROVING QUALITY AND SAFETY STANDARDS TAKING INTO ACCOUNT
ADVANCES IN MEDICAL SCIENCE
GOOD MEDICAL PRACTICES
NEW HEALTH TECHNOLOGIES
DIRECTIVE 201124EU OF THE EUROPEAN PARLIAMENT
WHERE ARE YOU GOING
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
IS IT TIME TO TAKE A HARDER LOOK AT THE QALY
HOW MUCH A PERSONrsquoS HEALTH ACTUALLY COST
HOW DO YOU DETERMINE THAT
SHOULD HIGH-PRICED BIOLOGICS BE COVERED IF THEY ARE NOT COST-EFFECTIVE
Amanda Brower Biotechnol Healthc v5(3) Sep-Oct 2008
PUTTING A PRICE ON TREATMENT
HEALTH CARE IS CHANGING RAPIDLY
ALL THINGS TO ALL PEOPLE-IMPOSSIBLE
MAKE CHOICES
HOW MUCH LONGER THE TREATMENT WILL ALLOW YOU TO LIVE
HOW IT IMPROVES THE LIFE YOU HAVE
J Bone Joint Surg Am 2005 Jun87(6)1253-9
ORTHOPAEDIC COMMUNITY UNDERSTAND AND APPLY ECONOMIC EVALUATIONS
IT CAN BE USEFUL FOR SETTING PRIORITIES AND GUIDING RESEARCH
Cost-utility analyses in orthopaedic surgery
Harvard Center for Risk Analysis Harvard School
HEALTH SYSTEMS IN THE UNION - EFFORTS TO ENSURE IMPROVING QUALITY AND SAFETY STANDARDS TAKING INTO ACCOUNT
ADVANCES IN MEDICAL SCIENCE
GOOD MEDICAL PRACTICES
NEW HEALTH TECHNOLOGIES
DIRECTIVE 201124EU OF THE EUROPEAN PARLIAMENT
WHERE ARE YOU GOING
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
PUTTING A PRICE ON TREATMENT
HEALTH CARE IS CHANGING RAPIDLY
ALL THINGS TO ALL PEOPLE-IMPOSSIBLE
MAKE CHOICES
HOW MUCH LONGER THE TREATMENT WILL ALLOW YOU TO LIVE
HOW IT IMPROVES THE LIFE YOU HAVE
J Bone Joint Surg Am 2005 Jun87(6)1253-9
ORTHOPAEDIC COMMUNITY UNDERSTAND AND APPLY ECONOMIC EVALUATIONS
IT CAN BE USEFUL FOR SETTING PRIORITIES AND GUIDING RESEARCH
Cost-utility analyses in orthopaedic surgery
Harvard Center for Risk Analysis Harvard School
HEALTH SYSTEMS IN THE UNION - EFFORTS TO ENSURE IMPROVING QUALITY AND SAFETY STANDARDS TAKING INTO ACCOUNT
ADVANCES IN MEDICAL SCIENCE
GOOD MEDICAL PRACTICES
NEW HEALTH TECHNOLOGIES
DIRECTIVE 201124EU OF THE EUROPEAN PARLIAMENT
WHERE ARE YOU GOING
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
ORTHOPAEDIC COMMUNITY UNDERSTAND AND APPLY ECONOMIC EVALUATIONS
IT CAN BE USEFUL FOR SETTING PRIORITIES AND GUIDING RESEARCH
Cost-utility analyses in orthopaedic surgery
Harvard Center for Risk Analysis Harvard School
HEALTH SYSTEMS IN THE UNION - EFFORTS TO ENSURE IMPROVING QUALITY AND SAFETY STANDARDS TAKING INTO ACCOUNT
ADVANCES IN MEDICAL SCIENCE
GOOD MEDICAL PRACTICES
NEW HEALTH TECHNOLOGIES
DIRECTIVE 201124EU OF THE EUROPEAN PARLIAMENT
WHERE ARE YOU GOING
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
HEALTH SYSTEMS IN THE UNION - EFFORTS TO ENSURE IMPROVING QUALITY AND SAFETY STANDARDS TAKING INTO ACCOUNT
ADVANCES IN MEDICAL SCIENCE
GOOD MEDICAL PRACTICES
NEW HEALTH TECHNOLOGIES
DIRECTIVE 201124EU OF THE EUROPEAN PARLIAMENT
WHERE ARE YOU GOING
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
WHERE ARE YOU GOING
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
THE FUTURE STARTS TODAY NOT TOMORROW
Pope John Paul II
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
ldquoTO MAKE NO MISTAKES IS NOT IN THE POWER OF MAN BUT FROM THEIR ERRORS AND MISTAKES THE WISE AND GOOD LEARN WISDOM FOR THE FUTURE
rdquo Plutarch 46 ndash 120 AD
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
MEDICAL ERRORS
ldquoPATIENTSrsquo PERCEPTIONS AND EXPERIENCE OF CARE ARE VERY IMPORTANT
PATIENTS MAY MISCHARACTERIZE AN OUTCOME AS AN ADVERSE EVENT OR COMPLICATION -LACK SPECIFIC MEDICAL KNOWLEDGE
Council on Research and Quality AAOS
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
ERROR DEFINITION
OCCASIONS IN WHICH A PLANNED
SEQUENCE OF MENTAL OR PHYSICAL ACTIVITIES
FAILS TO ACHIEVE ITS INTENDED OUTCOME
AND WHEN THESE CANNOT BE ATTRIBUTED TO THE INTERVENTION OF SOME CHANCE AGENCY
Professor James Reason
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
ΕRROR IS umlΑN ACTION OR DECISION THAT RESULTS IN ONE OR MORE UNINTENDED NEGATIVE OUTCOMES
(STRAUCH Barry (2004) Investigating human error incidents accidents and complex systems Ashgate (Aldershot UK)
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
WHEN FACED WITH UNCERTAINTY A SUBJECT CAN MAKE TWO POSSIBLE ERRORS IN THE DECISION MAKING PROCESS
A TYPE I ERROR IS A FALSE-POSITIVE
A TYPE II ERROR IS A FALSE-NEGATIVE OR THE SIDING WITH SKEPTICISM
Haselton M G amp Buss David (2000) Error Management Theory A New Perspective on Biases in Cross-Sex Mind Reading
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
REDUCING MEDICAL ERRORS AND ADVERSE EVENTS
Medical errors account for at least 44000 and perhaps as many as 98000 deaths per year in the United States They increase disability and costs and decrease confidence in the health care system
Annu Rev Med 2012 Johns Hopkins University School of Medicine
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
MEDICAL ERROR (HUMAN ERRORS IN HEALTHCARE)
A PREVENTABLE ADVERSE EFFECT OF CARE (whether or not it is evident or harmful to the
patient) This might include an inaccurate or incomplete
diagnosis or treatment of a disease
injury syndrome behavior infection
etc Zhang J Patel VL amp Johnson TR (2008)
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
MEDICAL ERROR
INAPPROPRIATE METHOD OF CARE OR RIGHT SOLUTION BUT EXECUTED IT
INCORRECTLY
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
CAUSES INADEQUATE DOCTOR-PATIENT COMMUNICATION NOT THOROUGH REPORT ON THE RISKS AND
BENEFITS OF EACH TREATMENT FAILURE TO DOCUMENT THE SELECTION BY THE
PHYSICIAN NON-VISIBLE AND NON UNDERSTANDABLE
MEDICAL NOTES
NON-COMPLIANCE WITH THE PROFESSIONAL-SCIENTIFIC RULES
THE RECORDED DISCREPANCY EG BETWEEN
DOCTORS AND NURSES IN MEDICAL DOCUMENTS httpwwwaaosorg
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
COGNITIVE FACTORS ARE CRITICAL AT VARIOUS LEVELS OF THE HEALTHCARE SYSTEM HIERARCHY OF MEDICAL ERRORS
Jiajie Zhang et al Am Med Inform Assoc 2002 Nov-Dec 9(6 Suppl 1) s75ndashs77 In science cognition is a group of mental processes that includes attention memory producing and understanding language learning reasoning problem solving and decision making
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
AT THE LOWEST CORE LEVEL IT IS INDIVIDUALS WHO TRIGGER ERRORS
( most critical role here) NEXT LEVEL
INTERACTIONS BETWEEN AN INDIVIDUAL AND TECHNOLOGY
AT THE NEXT LEVEL
INTERACTIONBETWEEN GROUPS OF PEOPLE WHO INTERACT S WITH COMPLEX TECHNOLOGY
AT THE NEXT FEW LEVELS UP ORGANIZATIONAL STRUCTURES INSTITUTIONAL
FUNCTIONS NATIONAL REGULATIONS
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
MEDICAL ERRORS INVOLVING TRAINEES ERRORS IN JUDGMENT ( [72]) TEAMWORK BREAKDOWNS ( [70])
(LACK OF SUPERVISION)
LACK OF TECHNICAL COMPETENCE ( [58])
Trainee errors appeared more complex than nontrainee errors
Houston Center for Quality of Care and Utilization Studies USA Arch Intern Med (2007)
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
REVIEWS OF LIABILITY CLAIMS AGAINST SURGEONS MOST ERRORS ARE PREVENTABLE
COMPETENT SURGEONS FAILURE TO OPERATE WITHIN A PROPER SCOPE-OF-
PRACTICE PATIENT FACTORS FAILED JUDGMENT AND POOR DECISION-MAKING
INSTEAD OF LACK OF KNOWLEDGE Adv Surg (2009) Department of Surgery Louisiana State University Health
Sciences
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
COGNITIVE ERROR - MEDICAL INJURY -CLAIMS IN JAPAN
COGNITIVE ERRORS ( ERROR IN JUDGMENT) WERE COMMON
POOR TEAMWORK (11274 4) and TECHNOLOGY FAILURE (5274 2) were less common
REDUCTION OF THIS TYPE OF ERROR IN JUDGMENT IS REQUIRED TO PRODUCE SAFER HEALTHCARE
J Hosp Med (2011)University of Tsukuba Japan
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
MODELS OF PHYSICIANndashPATIENT RELATIONSHIP
Number 395 January 2008
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
PATERNALISTIC MODEL ONLY INFORMATION ON RISKS AND BENEFITS
OF A PROCEDURE THAT THE PHYSICIAN THINKS
Indications Unconscious patients Patient is ill and unable to engage in a
discussion
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
INFORMATIVE MODEL
THE PATIENT HAS COMPLETE CONTROL OVER SURGICAL DECISION MAKING AND THE PHYSICIANS VALUES ARE NOT DISCUSSED
NOT IDEAL for patient care in most situations
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
INTERPRETIVE MODEL
PHYSICIAN ACTING AS AN INFORMATION SOURCE
HELPS THE PATIENT TO KNOW MORE CLEARLY
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
DELIBERATIVE MODEL SIMILAR TO THE INTERPRETIVE BEYOND THE INTERPRETIVE MODEL PHYSICIAN MUST CONSCIOUSLY COMMUNICATE
TO THE PATIENT HIS OR HER HEALTH VALUES
httpwwwmedicineoxacukbandolierpainresdownloadwhatisQALYpdf
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
WHEN OBTAINING INFORMED CONSENT FOR TREATMENT The orthopaedic surgeon is obligated to
present to the patient or to the person responsible for the patient in UNDERSTANDABLE TERMS PERTINENT MEDICAL FACTS AND RECOMMENDATIONS CONSISTENT WITH GOOD MEDICAL PRACTICE
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
SUCH INFORMATION SHOULD INCLUDE
Alternative modes of treatment
Objectives
Risks and possible complications of treatment
Complications and consequences of no treatment
Code of Ethics and Professionalism for Orthopaedic Surgeons AAOS
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
COUNCIL ON RESEARCH AND QUALITY -AAOS
EDUCATE ITS MEMBERS THE PUBLIC AND PUBLIC POLICY MAKERS REGARDING
evidenced-based medical practice orthopaedic devices
biologics regulatory pathways and standards development
patient safety occupational health
technology assessment and other areas of importance
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
The Patient Protection and Affordable Care Act (PPACA) -pressure on providers
to improve outcomes lower the cost of care
Market forces being exerted by both
consumers and businesses -demand for better healthcare at lower costs
httpwwwaaosorgnewsaaosnowjan13advocacy7asp
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
MEASURE QUALITY COST
QUALIFIED PHYSICIANS TO MEASURE QUALITY VALUE
PUBLIC AND PRIVATE PAYERS HAVE BEGUN TO DEVELOP THEIR OWN RATING AND PAYMENT SYSTEMS TO MEASURE PROVIDER COST AND QUALITY
Kevin J Bozic AAOS Council on Research and Quality
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
FUTURE QUALITY OBJECTIVES
ΙDENTIFY THE EVIDENCE GAPS AND QUALITY CHALLENGES
MEASUREMENT OF QUALITY AND PHYSICIAN PERFORMANCE
EMPHASIS ON PATIENT OUTCOMES AND
PATIENT SATISFACTION AAOS Council on Research and Quality
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
DEFINITIONS OF QUALITY OF CARE
NO CONSENSUS ON HOW TO DEFINE QUALITY OF CARE
LACK OF A COMMON SYSTEMATIC FRAMEWORK
(from European Observatory of Health System and policies Odservatory studies No 12)
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
DEFINITIONS OF QUALITY OF CARE THE DEGREE TO WHICH HEALTH SERVICES FOR
INDIVIDUALS AND POPULATIONS
INCREASE THE LIKELIHOOD OF DESIRED HEALTH OUTCOMES
CONSISTENT WITH CURRENT PROFESSIONAL
KNOWLEDGE
Doing the right things (what) bull
to the right people (to whom) bull
at the right time (when) bull
and doing things right first time
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT
PERFORMANCE MANAGEMENT AND QUALITY IMPROVEMENT TOOLS IN
ORDER TO INCREASE THE EFFECTIVENESS
Centers for Disease Control and Prevention
httpwwwcdcgovstltpublichealthperformance
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
MEDICAL ETHICS AND VALUES ARE FUNDAMENTAL ASPECTS OF HEALTH CARE ORGANIZATIONS
The Strategic Management of Health Care Organizations ndash
Peter M Ginter - 2013
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
UNIVERSITY OF PENNSYLVANIA HELATH SYSTEM
CORE VALUES AREEXCELLENCE CREATIVITY AND INNOVATION
INTEGRITY
DIVERSITY
PROFESSIONALISM
INDIVIDUAL OPPORTUNITY
TEAMWORK AND COLLABORATIONTRADITION
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
THE NHS WAS CREATED OUT OF THE IDEAL THAT GOOD HEALTHCARE SHOULD BE AVAILABLE TO ALL REGARDLESS OF WEALTH
MEET THE NEEDS OF EVERYONE
FREE AT THE POINT OF DELIVERY
BASED ON CLINICAL NEED NOT ABILITY TO PAY
(July 5 1948-now)
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
COMPREHENSIVE SERVICE
AVAILABLE TO ALL
EXCELLENCE AND PROFESSIONALISM
NEEDS AND PREFERENCES OF PATIENTS THEIR FAMILIES AND THEIR CARERS
BEST VALUE FOR TAXPAYERSrsquo MONEY AND THE MOST EFFECTIVE FAIR AND SUSTAINABLE USE OF FINITE RESOURCES
Department of Health published the NHS Constitution (which will be renewed every 10 years(March 2011)
GUIDING PRINCIPLES OF THE NHS
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
RIGHTS AS AN NHS PATIENT COVER HEALTH SERVICES ACCESS
QUALITY OF CARE
INFORMATION
CONFIDENTIALITY
RIGHT TO COMPLAIN IF THINGS GO WRONG
PUBLIC FUNDS WILL BE DEVOTED SOLELY TO THE BENEFIT
OF THE PEOPLE THE NHS SERVES
httpwwwnhsukNHSEnglandthenhsaboutPagesnhscoreprinciplesaspx
ΕΥΧΑΡΙΣΤΩ
ΕΥΧΑΡΙΣΤΩ