U.S. Office of Personnel Management - Ensuring the Federal Government has an effective civilian workforce

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. To coordinate our patient safety initiatives, we have assigned Enitza D. George as our patient safety officer in Republic of Panama, and Melida Grant, RN for our main offices in New Jersey. Final oversight of our safety initiatives is under the responsibility of our Medical Directors, Gaspar García 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).”

GOALS:

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.

ACTIVITIES:

1. Creating a culture of safety at HNA Panama. This must include all levels of management and staff. For 2003, we plan on continuously training the HNA Panama staff and head of departments using interactive training modules, small-group discussions, and written training materials.

At the managerial level, we will 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 systems 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 notices the member's social characteristics which may place him or her at risk for medication errors. She also points out any safety concerns she may notice during her evaluation. The Medical Director reviews the social worker's recommendation and eevaluates the member prescription and disease profile before approval.

3. Hospital Patient Safety Committees. We have already begun organizing a patient safety committee at Clínica San Fernando, our primary inpatient facility. This committee is integrated by representatives from the following departments: general management, medical director´s office, nursing, radiology, patient advocacy, laboratory / blood bank, pediatrics, intensive care unit, pharmacy, operating room, gynecology.

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

HNA Panama patient safety coordinator will work together with the hospital safety officers to encourage the systematic surfacing and reporting of serious adverse events and the production of credible “root cause” analyses of such events.

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 Committee, that meets quarterly. One of the Committee's primary responsibility 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.

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 2003 we will include preventive care measures as part of our physician 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.

EVALUATION TOOLS:

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 include known risky behaviors, as well as best practices. Experts have agreed that the sharing this information saves lives.

EXPECTED OUTCOME:

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.