Involvere pasienter i pasientsikkerhet.Erfaringer fra nederland, Ian Leistikow,Pasientsikkerhetskonferansen2015

1. The Role of Patients in
Patient Safety
Ian Leistikow, MD PhD
Senior Inspector at Dutch Healthcare
Inspectorate
Member Strategic Advisory Board of International
Forum on Quality and Safety in Healthcare
No conflicts of interest

2. Involving patients in designing and executing
patient safety policy
• Ensure professionals have positive attitudes,
are supportive and ask for feedback;
• Build infrastructure to do something about
patients’ comments;
• Make patients feel able and encouraged to
take part.
Health Foundation. Involving patients in patient safety. 2013

3. Involving patients in designing and executing
patient safety policy
“greater patient involvement may require
changing the culture of healthcare so that
patients and professionals are working as
partners in a joint team.”

4. Is there a parallel between
development of the role of patients
in Patient Safety
and
in Healthcare?

7. The Netherlands, 1969

8. 1969: A plea for patient engagement
• Doctors should be open and honest towards
patient about his illness and the treatment
possibilities
• Patients should be involved in the decision
making process.
• “I can see it happening that the
patient can freely browse through
his own patient record.”

9. Only 45 years ago
• We did not tell the patient what he/she had
• The ward nurse often wasn’t even told

10. Developments over the past 45 years
• Openness about illness
• Openness about treatment possibilities
• Openness about possible side effects of
treatment
• Training physicians in telling “bad news”
• Openness about inadequate result of treatment
• “Informed consent”
• “Shared decision making”
• “What’s the matter”  “What matters to you?”

11. Health Foundations recommendations:
• Ensure professionals have positive attitudes,
are supportive and ask for feedback;
• Build infrastructure to do something about
patients’ comments;
• Make patients feel able and encouraged to
take part.
Health Foundation. Involving patients in patient safety. 2013

12. Is there a parallel between
development of the role of patients
in Patient Safety
and
in Healthcare?

15. 1992 – 2000: My medical education
• Fallibility was not discussed explicitly
• Implicitly, fallibility was seen as character flaw
• Mostly, we did not even see unsafety in care,
let alone:
– Learn how to discuss it with each other
– Learn how to discuss it with the patient
– Learn how to prevent it

16. until 2003
the Dutch word for
patient safety
did not exist

17. Developments over the past 15 years
• Acknowledgement of patient safety as issue
• Openness about adverse events
• Training healthcare professionals in analysis
• Training physicians in being “bad news”
• Openness about the outcome of analysis
• Engaging patients in reconstruction of AE
• Sharing AE reports with the patient

18. Involving patients in healthcare/patient safety
• First we simply did not know
• Then we knew, but did not understand
• Then we understood, but did not see a role for
patients
• Then we told patients
• Then we engaged patients
• Then we empowered patients (healthcare)
• Now we see the patient as the “owner” (healthcare)

19. Experiences in the Netherlands
• Reluctance to involve patients in reconstruction
• Hospitals fear giving patients the AE analysis
report
• Patient and Hospital have different perception as
to what constitutes the AE
• Distrust of patients in fair process
• Difficult for patients to understand difference
between AE analysis and complaint/financial claim

20. 2013-2015: informing patients
n = 1700 reports

21. 2013-2015: engaging patients
n = 1700 reports

22. Future role of patients in patient safety?
• Empowered patients
• See the patient as the “owner” of his/her AE

23. Conclusion
• The role of patients in patient safety is developing
similarly as the role of patients in healthcare.
• Many challenges must be overcome, but we’ve
overcome them all before.
• We cannot predict the future, but we can make
an educated guess, based on the past
• When in doubt, think “what would I want if it was
about me?”

24. Thank you for your attention
ianleistikow@gmail.com