New Zealand patient safety expert calls for stronger collaboration in hospitals to protect patients

Healthcare regulators should engage proactively with clinicians and hospital managers to improve patient confidence in the health system before errors occur, according to the Head of the School of Medicine at the University of Auckland, specialist anaesthetist Professor Alan Merry.

Professor Merry, who also chairs the Board of the NZ Health Quality and Safety Commission, will present Errors and violations – the imperative to engage at the Australian and New Zealand College of Anaesthetists’ (ANZCA) annual scientific meeting in Brisbane on Monday May 15.
A leading expert on patient safety, Professor Merry said recent high profile international cases involving surgical mishaps or unnecessary operations highlighted the need for a more collaborative approach to ensuring high quality patient care by medical practitioners, health administrators and healthcare regulators.
“Consumers should also be part of the mix – what we are talking about here is care that patients need and value – and who better to know that than patients themselves?” he explained.
Professor Merry said that in New Zealand, the New Zealand Health and Disability Commissioner was already playing a vital and constructive role in ensuring patients’ concerns and complaints were heard and acted upon while the no-fault Accident Compensation Commission provided appropriate compensation and non-adversarial support.
But under the model he will present at the ANZCA meeting, expert patient safety officers would be introduced as independent monitors for patients in the public health system. They would get to know what was being done, every day, to ensure patient safety. Usually, they could reassure the public, but when necessary they could raise a ‘red flag’ – before harm occurred, not after.
‘’The Health and Disability Commissioner already undertakes inquiries with a strong focus on systems factors and has done great work in identifying problems and responding to complaints but I think we can go a step further,’’ Professor Merry explained.
“This could mean having safety officers working in hospitals who are effectively independent because they are accountable to an external legal agency (like the Health and Disability Commissioner, for example) and not the hospitals. Their role would be to understand and monitor the quality improvement and safety initiatives that are undertaken in hospitals.”
‘’Patients need to know they can trust their hospitals and clinicians. For this reason some countries publically report the results of some individual surgeons, but there are many flaws in this approach.  Our suggested approach could provide a more effective and comprehensive means of demonstrating to the public that the right systems are in place – as they often are.”
‘’At the heart of this approach would be an engaged, thoughtful and collaborative process. Money spent on health-related law suits is as much part of our limited medical budget as money spent on care – and in some countries it feels like both the lawyers and the ambulances wait at the bottom of the cliff.  There are better ways of improving healthcare and avoiding harm than by law suits after the event. New Zealand is ahead of the world in this regard, but we could do better still by working together.”
Professor Merry’s presentation is drawn from the principles of ‘therapeutic jurisprudence’ which is explored in a new edition of his book Merry and McCall Smith’s Errors, Medicine and the Law, published by Cambridge University Press, and co-authored with New Zealand academic lawyer Professor Warren Brookbanks.
Professor Merry said most healthcare was of a high standard but it was ‘’important for us as practitioners to take the lead in moving from idiosyncratic and occasionally arrogant practices to a more collective approach to excellence”.
‘’At the same time regulators and lawyers should start to be more proactive in improving standards of care, rather than simply waiting to respond after an event,’’ he said.
Professor Merry said New Zealand, with its innovative legislative framework was ‘’uniquely placed to continue to advance a culture of proactive excellence that utilises the resources of all those who work in providing and regulating healthcare and which genuinely reflects the needs and rights of patients and practitioners alike’’.
Professor Merry said patients don’t necessarily ‘’want to know who the best doctor is’’ when they are admitted to hospital, because in fact few of them would get to choose such an individual even if he or she existed.
‘’What they do want to know is that they will be looked after well (and I mean very well) in any of our hospitals. There is an opportunity here to work towards a better, proactive way of assuring the safety and quality of our health system.”
‘’The best response to patient harm is to prevent it from happening in the first place.”
The Australian and New Zealand College of Anaesthetists (ANZCA) is the professional organisation for about 6400 specialist anaesthetists (Fellows) and 1500 anaesthetists in training (trainees).
One of Australasia's largest specialist medical colleges, ANZCA is responsible for the training, examination and specialist accreditation of anaesthetists and pain medicine specialists and for the standards of clinical practice in Australia and New Zealand. 
For more information or to request interviews please contact ANZCA Media Manager Carolyn Jones on +61 408 259 369 or Follow us on twitter @ANZCA.

Monday May 15, 2017 
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