Session 14S1: Perioperative patient safety: the patient’s perspective

Session 14S1: Perioperative patient safety: the patient’s perspective

Saturday 2 June, 1400-1530H, Red Room 2

The session will cover patients´ views on perioperative patient safety from different perspectives: a patient’s view on perioperative patient safety is followed by the view of a physician that has experienced healthcare from “the other” side while being a patient. The third presentation addresses the importance of outcomes that matter for patients (and integrates patients’ views) for future improvement of perioperative patient safety, and for value-based transformation of healthcare.

The patient’s view is presented by Mrs Coby Omvlee, of Tronheim, Norway. She will describe her life as a hospitalised long-term patient, which she later refers to as a STAYER – this is the name of the play she has written for theatre in Norway, based on her experiences.

“In a car accident my small intestine was damaged, and I was given a temporary ileostoma and intravenous nourishment for three months, until the final operation. Or so we thought,” she explains. “But three months turned into 12: I was moved twice to other care institutions. Malnourished and without proper medical supervision my life was endangered twice.  The surgeons had lost their memory of my complicated state and operations failed terribly.”

The hospital became Mrs Omvlee’s home. And puzzled, she observed how today’s hospitals are run: cutting expenses, outsourcing and fragmenting medical responsibilities – she will ask in her talk what does this lead to for staff and patients, and patient safety?

“When finally discharged, my head was filled with questions. I needed answers, public answers, from health experts and administration. I decided to use this information to tell my story in the form of a play. After 27 interviews and three years of preparations, my theatre colleagues and I premiered STAYER,” says Mrs Omvlee. “During 53 minutes, the play deals with patient safety in health care. It touches, suggests, inspires and raises questions dealt with after the performance in conversations with audiences and experts. Working with this material has kept me sane and I feel lucky, not only for being alive, but also for sharing STAYER widely.”

The second talk, titled ‘being safe – through the eyes of a physician that became a patient’, will be given by Dr Paul Barach, Clinical Professor Wayne State University School of Medicine, Detroit, MI, USA.  His talk has three objectives:

  • Foster an appreciation of the lived reality of a patient/family and the patient’s perceptions of the clinical process of healthcare services.
  • Identify ways to implement a service mapping approach that recognises the compelling partnership between patients/families and healthcare professionals and improve the service experiences of patients and their families as they navigate the complexities of the healthcare system.
  • Discuss strategies to use improvement tools in caregiving teams and in healthcare professions education including multimodal enhanced community and hospital recovery after surgery (ERAS) to improve performance and service of cancer care.

Dr Barach will outline how cancer care service failures fall into two categories: breakdowns during a specific phase of care delivery and breakdowns during the transition between phases. “Being a practicing clinician and quality and safety improvement researcher challenged me and my wife as we navigated the complex, non-patient centred and often frustrating patient care pathways,” he says. “The breakdowns in communication and coordination of my care had significant implications for my wife and I that were mostly inapparent to the clinicians, yet greatly impacted my healing and wellness.”

While exceedingly grateful for the team that took care of him, Dr Barach remembers the awkward parts of the process.  “My wife and I sought to be active participants in my cancer care but often this was overlooked or met with a condescending smile. It seems that our input was not relevant and our expertise, over 45 years combined in quality and safety of surgical care, were not of interest. My wife and I were in need of greater attention and compassion by our hard working team of well-trained providers in a top ranked U.S. healthcare system. I needed help as a patient in the pursuit of full healing and return to my healthy state.”

Dr Barach will, in this talk, discuss common ‘fail’ points in the care he received, with a view to improving care for others. He will highlight the complex environmental human factors that impacted his care and describe his preventable healthcare acquired surgical site infection (SSI), medication drug error, hospital readmission, as well as how the uneven service contributed to his patient harm and frustration.

The content is based on original research on service improvement in cancer care and Dr Barach’s personal experiences as a cancer patient and that of his wife, a surgeon and devoted carer.  He concludes: “The talk will briefly touch on our work to redesign and identify ways to implement a patient and family caregiver-centred service blueprint model that can improve the service experience of cancer patients and their families as they journey from diagnosis through surgery and anaesthesia and back to wellness.”

The final part of the session is titled “Being safe – the importance of outcomes that matter to patients”, and will be presented by Dr Johannes Wacker, Consultant Anaesthesiologist at Hirslanden Clinic, Zurich, Switzerland and Chair of the Patient Safety and Quality Committee of ESA. “Avoiding preventable patient harm is the essence of patient safety, but as healthcare professionals, we tend to talk about patients and their safety rather than with patients about their safety. Why is this difference so important?” asks Dr Wacker.

He will highlight that first, the primary goal of healthcare is to use the available resources for achieving the best health outcomes for patients. This concept of healthcare ‘value’ has been defined by Harvard economist Michael Porter as the outcomes that matter to patients, relative to their costs. Hence, only individual patients can determine what constitutes their ‘value’, or what matters most to them when balancing desired outcomes against the risk of adverse outcomes.

Second, as increasing literature documents, patients are often willing to contribute their views not only about desired outcomes, but also about risks, and about their experiences of adverse outcomes. Patient’s reporting of safety-relevant observations may contribute to reducing actual patient harm, and provide important learning opportunities for institutions.

Third, continuous personal relationships and communication between patients and attending clinicians along the perioperative path may help to better integrate patient’s views, enable shared care decisions, and improve patient satisfaction.

Dr Wacker concludes: “Being safe involves patient’s individual perceptions of the balance between desired results and adverse outcomes. We can’t achieve real value without consistently integrating this perspective.”