One million reasons to change how you interact with the health care system: book

Being a patient can be a disempowering experience, and disempowerment can compromise safety.

A reminder of this is a small, hospital-based study done the US a few years ago, which found that, although 90% of participants thought healthcare workers should be reminded to wash their hands, only 54% would feel comfortable asking a doctor to wash his or her hands if he or she forgot, and 14% had ever plucked up the courage to do so.

Collaboration to increase handwashing is just one way in which patients can participate in protecting themselves in the health care environment. Patient participation was also identified as the third of eight major recommendations in the landmark, Berwick report on Improving the Safety of Patients in England, which stated,

“Patients and their carers should be present, powerful and involved at all levels of healthcare organisations from wards to the boards of Trusts.”

This speaks to the way we govern and organise health care but also to individual interactions and actions.

In the post below, Kate Ryder, a Nurse who has worked as a Patient Support Officer and Senior Investigator for the Health Care Complaints Commission, outlines why she has written a book aimed at empowering people to participate in making themselves safer in the health care environment, and her ongoing efforts to compile the “best patient safety guide possible”.

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Kate Ryder writes:

In the latest government reporting period of 2013-14, there were over 1 million ‘adverse medical events’ recorded in Australian hospitals, and these were just the ones that ‘resulted in, or have affected, hospital admissions’. These adverse medical events are avoidable incidents, caused by the actions or inactions of health care providers that impact negatively on patient health.

While it is not known how many of these resulted in permanent injury or death in Australia, Jeremy Hunt UK Secretary of State for Health recently estimated that over 1 million people die from ‘avoidable clinical mistakes’ every year in hospitals across the world. Despite the best efforts of the various health departments, the number of adverse medical events has increased over the years. It is a serious issue that requires urgent redress and one that, as a health professional, I feel personally embarrassed about.

Under the present arrangements in health care, consumers have largely been left out of the loop. While their experience of, and their satisfaction with, their health care has been sought, little attempt has been made to educate and empower patients to evaluate their health care in meaningful ways, and to raise their concerns directly with their health care providers. No attempt has been made to help them identify poorly performing health care practitioners.

In addition, the health care and regulatory systems tend to try and address medical adverse events from a health care provider perspective. They rarely try to do this from the patient’s perspective. Hence information that could be used to enable patients to protect themselves is either not collected or is rarely evaluated, and tends to be dismissed or largely ignored.

I am a Registered Nurse with more than 20 years of clinical experience, and a former Patient Support Officer and Senior Investigation Officer with the NSW Health Care Complaints Commission. I believe that in order to reduce the number of adverse medical events in hospitals we need to involve patients directly.

The imperative for patients to do this, comes from the fact that the majority of medical practitioners practise alone. Their work is largely unsupervised and is rarely evaluated unless something goes seriously wrong. Medical practitioners who engage in careless, ill-considered, deceitful, reckless, or otherwise unprofessional conduct can be extremely difficult to detect.

For this reason, I decided to write the book ‘An Insider’s Guide to Getting the Best out of the Health System’. Designed as a patient’s safety guide, the book takes you, step by step, from preparing to become a patient to being discharged from a hospital, and on into the future. Its aim is to help patients keep themselves safe, moving through the health system.

My book recognises that people have a right, obligation and desire to participate in their own health care. It is pitched to meet the needs of the first time user as well as the seasoned health consumer. As such it is written in a user-friendly manner, complete with easy to follow checklists and entertaining images.

The book covers topics such as:

• who should formulate their own medical file and why
• what should be in a medical file
• when to call an ambulance
• what a patient should be able to expect from a GP and what to ask
• how to choose a specialist, private clinic, public or private hospital
• what to be wary of when choosing a specialist or seeking treatment in a private clinic
• what to take to hospital
• where to have your peripheral cannula sited, and why
• what to be mindful of when receiving intravenous drugs and fluids, including blood
• how to protect yourself when undergoing the insertion of a urinary catheter
• the importance of complaining, who to contact, and when

Other areas include:

• how to avoid becoming a patient in the first place
• the need to co-opt others into looking after you
• the value of adopting preventative health care plans
• how to protect the system as a whole by looking after nurses, donating bodies to medical science, investing in health initiatives and participating in health research.

This book not only provides information to help patients to protect themselves from health care providers, it can also act as a guide for inexperienced or careless health care workers. Knowing their patients are better educated and informed will encourage practitioners to strive to integrate ‘best practice’ at every level of their own clinical practise.

This project marks the beginning of an endeavour to compile the best patient safety guide possible, not only in Australia, but worldwide. With this in mind, I extend an invitation to all patients, health care providers and others such as academics and representatives from international, national, state and territory-based health organisations to become involved so that health outcomes for patients can be improved across the board. As Norm MacC stated in his email to me: ‘To be in Hospital and have one of these on the bedside table could have an interesting effect.’

Kate Ryder is a Registered Nurse with more than 20 years of clinical experience in both public and private hospitals in England and Australia. She has also worked as a Patient Support Officer and as a Senior Investigator with the Office of the Health Care Complaints Commission.

For more information about her book, and/or to contribute to her ongoing project, go to her website.