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Healthcare Plan Information

The Panama Canal Area Benefit Plan Administered by Health Network America and HNA Panama

Health Network America and HNA Panama have taken the stand that one preventable error is one error too many. Final oversight of our safety initiatives is under the responsibility of our Medical Directors, Gaspar Garcia de Paredes, MD in Panama and Jay Flynn, MD in New Jersey.

When organizing our initiatives, we embraced the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), definition of patient safety.

"Patient safety is a state of mind that recognizes the complexity and high-risk nature of modern health care; a set of processes (reporting, investigating, analyzing, reducing hazards, improving); and a set of outcomes (fewer errors, less risk)."


The main goal of our patient safety initiatives and programs is to replace traditional barriers to patient safety with a new culture of accountability, trust, system improvement, and continuous learning.


  1. Creating a culture of safety at HNA Panama. This must include all levels of management and staff. At the managerial level, we develop and monitor concrete, planned actions, and clinical protocols to reduce the likelihood of errors. Reporting and analyzing an event must lead to the development of planned system changes and an organizational response that results in preventive actions.

  2. Our Disease Management Program: This program includes the following elements:

    1. Care Management: Which is applicable to members who: are frail, chronically disabled, functionally and/or emotionally impaired, have long-term, medically complex problems requiring multifaceted, costly care, or are severely compromised by an acute episode of illness or acute exacerbation of a chronic illness.

    2. Focused Care Management: Which include all members with catastrophic illnesses, or that have had two or more hospitalizations or emergency visits in the past six months for the same diagnosis.

    3. Follow-Up Care: Follow-up phone calls are made to all members that are discharged from the hospital after an inpatient stay. Further follow-up calls will be done based on assessment of member's educational needs and their level of understanding.

    4. Drug Utilization Review: To prevent and identify prescription drug errors, we have insisted that providers write prescriptions legibly, and have established the policy of using generic drug names whenever possible.

      Prescription drugs benefit is a flexible benefit of this Plan. Our social worker and our Senior Medical Director before approval, review all cases where patients request this benefit. During her review, the social worker identifies the member's social characteristics which may place him or her at risk of inability to acquire medications. The Medical Director reviews the social worker's recommendation and evaluates the member prescription and disease profile before approval.

  3. Hospital Patient Safety Committees. We have already organized patient safety committees at Clinica San Fernando and Centro Medico del Caribe, our primary inpatient facilities. The management, medical director's office, nursing, radiology, patient advocacy, laboratory/blood bank, pediatrics, intensive care unit, pharmacy, operating room, and gynecology are members of the committees.

    We work with the hospital patient safety committees to establish explicit patient safety standards. Compliance with these patient safety standards is evaluated through periodic onsite inspection processes.

    Our Medical Director and the Care Manager Nurses work together with the hospital safety officers to encourage the systematic reporting of serious adverse events and the production of credible " root cause" analyses of such event. Creation or reviews of Hospital Protocols for care are encouraged.

  4. Physician Education and Monitoring:
    We routinely include patient safety information in our physician communications via memorandums, our website and newsletters. Our Senior Medical Director regularly issues evidence-based guidelines to doctors for treatment recommendations. These guidelines are developed with collaboration of our practicing network physicians.

    In 2002 we organized a Medical Quality Assurance and Credentialing Committeethat meets quarterly. One of the Committee's primary responsibilities is to assist us in determining whether providers are rendering services in accordance with accepted standards. This committee includes representation from the major clinical specialties relevant to our members. The Committee is composed of ten active providers who are not HNA employees.

    We perform annual evaluations of our primary care physicians and share with them a report card. This report card reflects their performance for the previous year in regards to established guidelines and standards. For 2004 we will include compliance with preventive care measures as part of our PCP evaluation.

    When necessary, our Medical Directors share patient prescription drug profiles or patient disease profiles with individual providers.

  5. Patient Education, Treatment and Follow-up as part of our Disease Management Programs. No matter how much we work at improving our systems at HNA Panama, or making providers and facility administrators aware of the issues relating to patient safety, patients themselves must become active participants in their care.

    In addition, patients have responsibilities in ensuring their own safety. In regards to safety, patients must:

    • Report perceived risks in their care
    • Ask questions when instructions are not clear
    • Follow instructions regarding care, services and treatment plan developed
    • Express concerns regarding their ability to follow and comply with the proposed care plan

    The patient family or surrogate decision-maker assumes the above responsibilities for the patient if the patient is unable to do so.

    During their evaluations and interactions with patients that are hospitalized, our nurses and social workers discuss patient safety issues with members. As part of the discharge planning and disease management procedures, our nurses instruct the member and their family regarding safety. To facilitate this task, we have planned on acquiring additional patient education materials regarding safety.


To evaluate the results of the activities described above, we have started working with our information system and biostatistics staff in New Jersey to aggregate, and analyze experiential information learned from errors. Our newly developed call management section in our information system will facilitate this process.

The results of our data analysis will be shared with hospitals, providers and members via newsletters, memorandums, our website and other routine communications. Important information that must be shared includes known risky behaviors, as well as best practices. Experts have agreed that the sharing of this information saves lives.


By developing specific standards, agreed upon procedures, and safety guidelines, Health Network America and HNA Panama will ultimately ensure a safer environment and better quality of care for the members of the Panama Canal Area Benefit Plan.

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