1. 13. International Conference on Health Promoting Hospitals, 2005 Listening to the Patient in Solving Problems Related to Treatment Errors Maria Hallman-Keiskoski M.Sc. in Health Education, Director of Nursing Central Finland Health Care District E-mail: maria.hallman@ksshp.fimaria.hallman@ksshp.fi

2. 13. International Conference on Health Promoting Hospitals, 2005

3. My Background Work as a head nurse with specialisation in health promotion (1991  ) Experience of work as a patient rights advocate in addition to my regular job (1993-95; 1998-99) Finnish coordinator of the WHO Health Promoting Hospitals (HPH) network (2000 ->)

4. 13. International Conference on Health Promoting Hospitals, 2005 According to distinguished international studies, hospital care caused unexpected problems that were independent of the disease for about 10% of the patients. About half of these problems could have been prevented!

5. 13. International Conference on Health Promoting Hospitals, 2005 A Study with the Patient Voice Forster, Murff, Peterson et al. 2003 Sample: Telephone interview 2-5 weeks after discharge, case summaries, N = 400 Results: 76 patients had adverse events after discharge (19%). 30% of them could have been prevented, and 32% had ameliorable adverse events.

6. 13. International Conference on Health Promoting Hospitals, 2005 The Need to Hear the Patient Voice Based on the literature, patients have an urgent need to openly discuss the incident. There is also a need to try to rebuild patient trust and give patients support for coping.

7. 13. International Conference on Health Promoting Hospitals, 2005 Case Study Design 1. Story by the patient (recorded) 2. Investigation (patient records + investigation report) Prof. Vincent et al. Investigation Protocol used 3. Feedback discussion (recorded) (patient, family member, people involved in care and/or experts, chief doctor as a chair, researcher) 4. Interviews with feedback discussion participants (recorded)

8. 13. International Conference on Health Promoting Hospitals, 2005 Study Question What do patients describe as treatment errors?

9. 13. International Conference on Health Promoting Hospitals, 2005 Voluntary Patients in Study Sample In 2004, in a period of two months, a total of 2 162 patients received a handout on the study when arriving at the Emergency Room of Central Finland Central Hospital. Sixteen of them contacted the researcher, and three were chosen to the study sample. ”If your care at the emergency room involves aspects that you find undesirable (e.g. difficulties in receiving care, vagueness in the examination or treatment, waiting time) and you wish to settle them, please contact the researcher:” Two additional patient cases from the year 2003, reported by staff, were also included in the study.

10. 13. International Conference on Health Promoting Hospitals, 2005 Diagnoses of the Patients 1. Ruptura musculus biceptis femoris l.sin 2. Fractura radii typica l.sin 3. Fractura radii l.dx 4. FA acuta/subacuta, Infarctus cerebri cum hemiparesis l.sin susp 5. Contractiones prematurales h 22+1 All of these cases were close-call situations.

11. 13. International Conference on Health Promoting Hospitals, 2005 Research Data Transcribed recordings (N=5) Story by patient / in 3 cases joint interview with a family member The patient was asked: ”What happened?” - free description of events The story continued for as long as the patient wanted - from hospital/home to health centre, etc. Patient records (N=5) Principal research method: content analysis

12. 13. International Conference on Health Promoting Hospitals, 2005 Treatment Errors Identified by the Patients Pain-related: insufficient anaesthesia, inadequate pain assessment, fear of being labelled as ”sickly” Shortcomings in basic care: insufficient infusion / nutrition; coldness Access to medical examinations: unnecessary delays, inaccurate situational diagnoses by physicians, problems in communication btw. emergency and x-ray department Functionality of the health care system: vague practices, problems in cooperation btw. units

13. 13. International Conference on Health Promoting Hospitals, 2005 Conclusions from Listening - Viewpoint of the Organization Listening provides valuable information about the experiences of individual patients, as well as about the functionality of the patient care chain. It can bring out organisational problems that are easily fixable. Listening is also an excellent tool in improving the quality of health care. It can help us understand the background of problems related to treatment errors. The results cannot be generalised, but we can learn from each individual case.

14. 13. International Conference on Health Promoting Hospitals, 2005 Conclusions from Listening - Viewpoint of the Patient The patients believed that the study promotes the solving of organisational problems felt that the clarification process promotes coping were happy to receive proper medical information felt that it is better to solve things this way than to quarrel about the clinical incident

15. 13. International Conference on Health Promoting Hospitals, 2005 The future strength of Health Promoting Hospitals will be the systematic involvement of patients and their family members in the proactive anticipation and solving of treatment errors! Conclusions from Listening - Viewpoint of the Researcher