Skip to main content

Currently Skimming:

7 Setting Performance Standards and Expectations for Patient Safety
Pages 132-154

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.


From page 132...
... Standards can be developed and used in public regulatory processes, such as licensure for health professionals and licensure for health care organizations, such as hospitals or health plans. Standards can also be developed through private voluntary processes, such as professional certification or organizational accreditation.
From page 133...
... RECOMMENDATIONS In the health care industry, standards and expectations about performance are applicable to health care organizations, health professionals, and drugs and devices. The committee believes there are numerous opportunities to strengthen the focus of the existing processes on patient safety issues.
From page 134...
... Public and private purchasers have three tools that can be employocl to clay to demand better attention to safety by health care organizations. First, purchasers can consider safety issues in their contracting clecisions.
From page 135...
... 135 For most health professionals, current methods of licensing and credentialing assess knowledge, but do not assess performance skills after initial licensure. Although the state grants initial licensure, responsibility for documenting continued competence is dispersed.
From page 136...
... proposed drug names to identify and remedy potential sound-alike and look-alike confusion with existing drug names; and · work with physicians, pharmacists, consumers and others to establish appropriate responses to problems identified through postmarketing surveillance, especially for concerns that are perceived to require immediate response to protect the safety of patients. FDA's role is to regulate manufacturers for the safety of their drugs and devices; however, even approved drugs can present safety problems when used in practice.
From page 137...
... In health care, standards are set through both public, regulatory initiatives and private, voluntary initiatives. Standards can apply to health care organizations, health professionals, and drugs and medical devices.
From page 138...
... ICAHO accredits more than 18,000 health care organizations, including hospitals, health plans, home care agencies, and others.3 Its longeststanding accreditation program applies to hospitals. ICAHO accredits hospitals for three-year periods based on compliance with its standards in the areas of patient rights and patient care: organizational performance; leadership; information management; and nursing and medical staff structures.
From page 139...
... Beginning in July 1999, accreditation criteria began to incorporate HEDIS measures, initially being used only if they increase a health plan's overall score.4 Accreditation status will also change with the top 20 percent of health plans earning the status of "excellent." URAC was established in 1990 and offers nine different accreditation programs for managed care organizations, such as health plan accreditation, health network accreditation, health utilization management accreditation, and network practitioner credentialing.5 Individual managed care organizations can seek accreditation under different sets of programs depending on the range of services they offer. URAC accreditation focuses on preferred provider organization (PPO)
From page 140...
... In a survey of 33 large purchasers in four states, 45 percent reported using HEDIS data (i.e., NCQA's Healthplan Employer Data and Information Set quality indicators) , 55 percent reported using accreditation data, and 53 percent reported using consumer satisfaction survey data to choose a health plan.7 Although some large employers have incorporated quality considerations into their purchasing decisions, this is not the norm.
From page 141...
... STANDARDS FOR HEALTH PROFESSIONALS Performance standards and expectations for health professionals may be defined through regulatory and other oversight processes, such as licensing, accreditation, and certification. Standards and expectations may also be shaped by professional societies and other groups that voluntarily promulgate guidelines or protocols and sponsor educational and convening .
From page 142...
... . Another issue related to professional licensure is that there is no continuing assessment or required demonstration of performance after initial licensure is granted, except for physician assistants and emergency medical technicians.20 In general, the state is involved in initial licensure or followup of complaints; processes for documenting continued competence are voluntary.
From page 143...
... Health care organizations are also involved in assessing the continued performance of professionals when hiring nurses or creuentialing physicians
From page 144...
... For example, an unsafe provider may be dismissed from one hospital, with no notification to the licensing board and limited ability for the next hospital to find out the reasons for the dismissal. The Pew Health Professions Commission conducted an extensive investigation of licensure and continued competency issues.
From page 145...
... convened a one-day workshop on September 9, 1999 with 14 health professionals representing medicine, nursing, and pharmacy (workshop participants are included in the acknowledgments)
From page 146...
... Most care delivered today is done by teams of people, yet training often remains focused on individual responsibilities leaving practitioners inadequately prepared to enter complex settings. Improving patient safety also requires some understanding of systems theory in order to effectively analyze the many contributing factors that influence errors.
From page 147...
... Professional societies can play a role not only in informing their members about patient safety, but also in calling attention to the issue among the general public. Implementation of activities to increase the role of health professionals in patient safety must occur at multiple levels.
From page 148...
... It should be noted, however, that the FDA regulates manufacturers, not health care organizations or professionals. There are two opportunities for FDA to ensure and enhance patient safety: during its approval process for drugs and devices, and through postmarketing surveillance.
From page 149...
... This could include name changes or withdrawal of a product from the market. The final type of action that FDA can take is communication about risks, including letters to physicians, pharmacists, and other health professionals, postings on the Internet, and publication of clinical and consumer journals.
From page 150...
... Controls on defibrillators can also vary in position, appearance, and function on different machines, leading to errors when they are used rapidly in emergency situations. Although the increased attention to human factors principles does not affect devices already on the market, over time it is expected that manufacturers will become more accustomed to using human factors in the design of medical devices.
From page 151...
... SUMMARY The main sources of standards for health care organizations and professionals today are through licensing and accreditation processes. However, medical errors and patient safety are not an explicit focus of licensing and accreditation.
From page 152...
... Group purchasers have the ability to consider safety issues in their contracting decisions, and to reinforce the importance of safety by providing relevant information to employees and beneficiaries.
From page 153...
... Wolfe, "Public Citizen's Health Research Group Ranking of State Medical Boards' Serious Disciplinary Actions in 1998," April, 1999, http://www.citizen.
From page 154...
... Making Medicine Safer, The Need for an Independent Drug Safety Review Board.


This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More information on Chapter Skim is available.