As more and more people survive into old age, the burden of caring for them becomes greater and greater. Although it is now possible to alleviate many of the afflictions that beset mankind, no society can afford to pay for all the healthcare that is now available or technically possible. People working in healthcare increasingly have to do more with less. Rationing takes many forms, mostly covert, and the less privileged in most societies end up struggling to get their proper share of the available healthcare resources. All too often, those in the front-line have to deal with the consequences of this 'rationing by default': healthcare professionals find themselves rushed off their feet simply doing the basic tasks and completing all the paperwork; placing frail, sick people in ever lengthening queues, sometimes asking them to wait for hours in the middle of the night under uncomfortable and even unsafe conditions; and, worst of all, working under conditions they would rather avoid in which the safety margin for those they are caring for has been greatly diminished. We are all aware that under these conditions the chance of making a mistake which can seriously harm or even lead to the death of a patient is greatly increased. But what can be done about this? How can you be sure that you are doing the right thing when faced with having to practise an uncertain science on vulnerable patients in a complex system under ever-changing conditions? At what point could you cross the invisible line from reasonable to irresponsible or unethical behaviour by tolerating conditions or tacitly accepting practices which may be regarded as unacceptable, even though you may have little immediate control over them? This book is a guide to getting it right for healthcare professionals. It is about doing the right thing, in the right way, at the right time, for the right people. These are the dimensions of quality in healthcare, and although some are in conflict (equitable access and efficiency, for example), adherence to ethical practice and professional behaviour will help lead healthcare practitioners through the minefield of responsibilities and priorities. Real-life situations are integral to the book, with over 500 clinical examples referred to within the text.
Table of Contents
Contents: Foreword; Preface. Part 1 What is Wrong with Healthcare: Setting the stage: an overview of healthcare; Risk and the harm caused by healthcare; Healthcare: a dysfunctional system; Naming, blaming and shaming. Part 2 Understanding the Basics: Human error and complex systems; Knowing what to do; Ethics, professional behaviour and regulation. Part 3 What to Do When Things Go Wrong: When things go wrong: looking after the people involved; When things go wrong: preventing a recurrence. Part 4 Preventing Things from Going Wrong: Getting the best out of people; Getting the best out of the system; Where to now? Appendices: Preferred terms and definitions for key safety and quality concepts; Public expenditure on healthcare in selected countries; Risk matrix; Evidence-based medicine: sources of information; International code of medical ethics; Jonsen's ethics framework; Severity assessment code (SAC); The advanced incident monitoring system (AIMS); Soft systems methodology (SSM); Sources of information for patients. Index.
Bill Runciman is Professor of Anaesthesia and Intensive Care at the Adelaide University and Head of the Department of Anaesthesia and Intensive Care at the Royal Adelaide Hospital. He founded the Australian Patient Safety Foundation in 1988, and is the current President. He has been a member of task forces which produced world patient safety standards for both Anaesthesia and Intensive Care. He was Chairman of the Safety and Quality of Practice Committee of the World Federation of Societies of Anaesthesiologists from 1992 to 2000. He has been a member of the Australian Council for Safety and Quality in Healthcare and of the Australian Health Information Council, and is joint co-ordinator of groups developing research tools and an International Patient Safety Classification for the World Alliance for Patient Safety of the World Health Organization. Alan Merry is Professor of Anaesthesiology at the University of Auckland. He chairs the Quality and Safety Committee of the World Federation of Societies of Anaesthesiologists. He is a Councillor of the Australian and New Zealand College of Anaesthetists, chairs the College's Quality and Safety Committee, and has chaired its New Zealand National Committee. He co-chaired the New Zealand Medical Law Reform Group and has been president of the Auckland Medico-Legal Society. He is co-author of the books Errors, Medicine and the Law (with Alexander McCall Smith; Cambridge University Press, 2001) and Essential Perioperative Transoesophageal Echocardiography (with David Sidebotham and Malcolm Legget; Butterworth-Heinemann, 2003). Merrilyn Walton is an Associate Professor in the Faculty of Medicine at the University of Sydney. She chairs the Personal and Professional Development Theme and teaches students and clinicians about ethical practice, quality and safety. Her interests include enhancing the training environment for medical students and doctors and advocating for patients to be fully engaged in health care at every level. She was the founding Commissioner for the NSW Health Care Complaints Commission (1993-2000), and is a board member of the NSW Institute for Medical Education and Training and chairs its Prevocational Training Council.
'This book is indeed a worthy addition to the debate on healthcare safety and quality. It is accessible and underscores the essential humanity in providing safe, technically advanced care. Fucusing on health systems shifts responsibility away from a simplistic individual or profession approach to a collective approach where all the stakeholders are involved: individuals, patients, healthcare teams, organisations, together with local, national and international levels of healthcare policy and decision making. Nurses' experiences in healthcare teams are not well-discussed: issues such as the impact of staff shortage and fatigue are discussed from a predominantly medical point of view. Having said this, I recommend strongly that nursing leaders read and re-read this book. Above all, it is imperative that systems and professionals provide effective and safe healthcare, and this rests with the whole healthcare team.' Journal of Advanced Nursing, 2007 '...this book is very good value and should be readily available in every area of our healthcare system. I am not aware of any other text so up to date and comprehensive.' Anaesthesia and Intensive Care Vol 35 No 5 October 2007 'The authors treat the topic "safety management in medicine" and turn thereby to one of the most urgent areas of research and development in surgery. Particularly in chapters 2 "Understanding the basics" and 3 "What to do when things go wrong" definitions and concepts from the field of Human Factors are introduced which are unknown in surgery so far. This is of great importance, because due to the introduction of assistance systems and advanced workflow-management techniques into the operating room, an enormous need exists to arrive at such a new description of the hospital as a high-risk environment. Our working group already took over numerous recommendations of the authors. For example, a meeting to openly discuss complications during surgical procedures was established on a regular basis. In ad