Responsibility assumes that we know the alternatives, that we know how to choose from among them,
and that we use this knowledge to push them aside through cowardice, opportunism, or ideological fervor

Paul K. Feyerabend
Killing Time: The Autobiography of Paul Feyerabend (1999)

Responsibility and Accountability in HEALTHCARE

Responsibility is a form of trustworthiness: it is the trait of being answerable to someone for something. The relevance of this meaning is clear, either in social and political context. In the healthcare systems the significance of Accountability became even more complex, considering the dynamic concept in which meanings and contents are layered in relation to the public need for information. Information that is essential in order to improve the quality of the healthcare systems and the sustainability of their insurance protection.
Accountability in the healthcare system demands the development of valid and reliable measures of quality.
Among these measures, we can identify:

  • the recognition of the need for a wide systemic change
  • the need to establish a clear policy for responsibility for functions related to Safety and improvement;
  • the ability to master and apply modern methods for quality planning, control and improvement
  • the ability to establish a High Reliability Organization
  • the imperative of working with multidisciplinary teams to achieve excellent healthcare goals
  • the acknowledgement of professional excellence as a key factor to impact on evidence-based risk management
  • the need to involve patients and their relatives in the whole healthcare process, empowering and educating the patients and their immediate Social Network as partners in the process of care
  • the approach to trust the goodwill and the good intentions of the staff and to be cautious about using blame
  • the need to provide appropriate training and continuous medical education programs
  • the aptitude to learn from failure and to be pro-active in the risk assessment.

Iatrogenic and unwanted medical errors evoke strong opinions and raise issues of fairness, Quality, Competence, Responsibility and Accountability.
The tendency to assign blame when mistakes occur is inimical to an environment in which we hope that learning and improvement will take place. But at the same time there is some unerasable need to hold people accountable for egregious errors.
Systemic problems in procedures are very often beyond the single case.
If we want to establish an environment that promotes disclosure of errors and near-misses, the fastest way to drive reporting underground is to punish someone who has made a mistake.
People in the medical field are well intentioned and feel great distress when they harm patients.
Medical negligence is almost always committed by the well-intentioned, because medicine is a risky business that someone must manage.
It is growing factor that the healthcare community takes errors very seriously, and there are many fail-safe mechanisms in place at most if not all hospitals and healthcare centers.
It has been demonstrated that while punitive actions may reduce deliberate reckless behaviour, it is not effective in reducing the occurrence of most types of human errors. We also know this from our day-to-day lives, where inadvertent errors are quite common. For example, even though the consequences to refuel with petrol instead of diesel are potentially severe, many people have made this error, some more than once (modern vehicle design and refueling system has made it virtually impossible to refuel the car using the wrong fuel).
Errors must be used to reinforce a learning environment in which we are fixed on the problems rather than inflexible on the people.
Whoever commit an error must show concern for the patient who suffered. We need to change the culture regarding the disclosure of medical errors. As clinicians we cannot learn from what we do not know and what we do not know can seriously harm our patients.
Any detected error must be reported before it develops the potential to cause harm. Like realizing that a wrong dose of medication could be administered to a patient or that a patient has been wrongfully listed to get a procedure due to an error in the electronic system. And the institutions must also work on discovering how the errors occurs to prevent similar ones. It is not an easy task to change the current culture and to establish a new paradigm, but we must start.
The current healthcare focus on personal blame has been tried for decades and it is not making us safer. Instead, we need to turn our cultural approach and to recognize that bright, well-educated, skilled and well-intentioned professional will make errors.
To become safer, we need to allow discussion of these errors, to understand them, to learn from them and to redesign our systems to reduce their likelihood and to mitigate their consequences. We can’t do this unless doctors and nurses feel safe enough to be transparent about their errors.
Should we continue with the same ineffective approach to the healthcare Safety that we have used so far? Or do we follow the lead of other safety-critical high-reliable industries and service providers?
Physicians have a powerful incentive to apologize when they make a mistake: doing so may decrease the likelihood that they will be sued.
In 2010 a paper has been published in the journal Annals of Internal Medicine showing that the average monthly rate of malpractice lawsuits fell by more than half after the physicians routinely apologized for their errors and offered fair compensation to the patients and their families.
Healthcare professionals are human and are involved in that most human activity of art and science: medicine. The trouble with medical errors is that too much energy is focused on punishing those who make errors and not enough in using those errors as opportunities to improve the delivery of care for everyone.
Healthcare, as an industry, has often failed to police itself, letting incompetent operate in a very critical environment. This issue will not be solved by lawyers or by regulators alone. It will be resolved practitioner by practitioner, patient by patient and system by system, through a dedication to admitting errors when they occur, forgiving the error, removing the incompetent and all working together toward better reporting, better outcomes and Accountability across the board.
Any patient who is harmed deserves a full disclosure, a sincere apology, an appropriate compensation and an explanation of how the event will be studied to improve care in the hospital.
Sharing of information, development of knowledge and research, consistent education and training followed by continuing medical education program are an important part of a learning culture.
When an error or a near-miss can be identified as something that It could have happened to anybody is a relevant sign that reflect a systemic, rather than a personal, problem.

Healthcare Safety and Accountability
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