Empowering Patients to Improve Safety

In 1999, the Institute of Medicine’s (IOM’s) groundbreaking report To Err Is Human caught the attention of the public and policy makers alike. It triggered efforts among a variety of organizations to attempt to follow the IOM’s call to build a safer health system. Over the past 5 years, the health care community was forced to confront the issue of patient safety, and progress has been made to enlist the support of stakeholders, change practices, and view error prevention as a priority. Despite this, many leading advocates of the patient safety movement recognize that there is little evidence that these efforts have come close to achieving their goal. Given these facts, what can patients do to ensure their own safety? The resources available to patients now are much more robust. Today, patients frequently use the Internet to learn about health. A current report found that 79% of Internet users, or approximately 95 million American adults, have searched for at least 1 major health topic online. This democratization of health information allows patients to play an educated and active role in their care. One such site that we have been working on, www.myexpertdoctor.com, uses evidence-based guidelines to encourage patients to ask questions during doctor visits that will lead to positive changes in their care. A preliminary study among migraine patients showed the site to be potentially useful. These developments are promising for the outpatient setting, but most patients cannot use the Internet’s rich health resources while hospitalized. A tremendous opportunity exists to improve patient safety by empowering patients to be active participants in their own care, but it appears to be underused. Patients who are involved in their own care have better outcomes. Nearly all patients are aware of a situation in which a medical mistake was made, and more than half are concerned about being given the wrong medicine or having complications from medical procedures. What can be done to make the most of this potentially powerful yet latent resource? It is important to realize that asking patients to be active participants in their own care is no small task. A recent study found that fewer than half of patients could state the reason for their hospitalization. Many patients, even highly educated ones, do not believe they are qualified to interpret health information. Nearly half of all adults in the United States have trouble understanding and using health information. It is clear that patients need assistance to be effectively involved in their own care. Some existing strategies have great potential. One important nationwide project is the “Speak Up” program launched by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Centers for Medicare & Medicaid Services. This campaign uses the acronym SPEAK UP to provide advice to patients. It advises patients to Speak up if you have questions or concerns; Pay attention to the care you are receiving; Educate yourself about your diagnosis, tests, and treatment plan; Ask a trusted family member or friend to be your advocate; Know what medications you take and why you take them;Use accredited health care organizations; and Participate in all decisions about your treatment. Each general recommendation is followed by specific questions for patients to ask and appropriate times to ask them. Since the launch of the general Speak Up program in 2002, 6 more programs have been created on topics such as wrong-site surgery, medication mistakes, and organ donation. Brochures and materials about Speak Up are available without copyright permission through http://www .jcaho.org. A 2002 JCAHO survey revealed that more than half of accredited organizations have reproduced or purchased the program materials. Another initiative is “Partners in Your Care,” a program for patients, families, and health care workers to encourage and monitor hand hygiene compliance. One of the central goals is to have patients ask health care workers to clean their hands. This pro-