Legislation and the establishment of an open and learning culture in health care Henning Boje Andersen 1 and Niels Hermann 2 1 Risø National Laboratory, Roskilde, Denmark 2 National Board of Health, Copenhagen, Denmark Annual Conference of the Society for Risk Analysis - Europe: INNOVATION AND TECHNICAL PROGRESS: BENEFIT WITHOUT RISK? 11-13 September 2006, Ljubljana, Slovenia
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Legislation and the establishment of an open and learning culture in health care Henning Boje Andersen 1 and Niels Hermann 2 1 Risø National Laboratory,
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Legislation and the establishment of an open and learning culture in health care
Henning Boje Andersen1 and Niels Hermann2
1Risø National Laboratory, Roskilde, Denmark
2 National Board of Health, Copenhagen, Denmark
Annual Conference of the Society for Risk Analysis - Europe:INNOVATION AND TECHNICAL PROGRESS: BENEFIT WITHOUT RISK?
11-13 September 2006, Ljubljana, Slovenia
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National project prior to legislationNationally funded project 2001-02:• Focus group interviews with doctors and nurses • Questionnaire survey • Overview of international literature on reporting
systems in medicine and other domains • Recommendations for a reporting system at the
national level and local levels
Prooject partners: DSI Institute of Health Care; Danish Inst. of Medical Simulation, Herlev Hospital; Risø National Lab., Denmark
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Project background & impactBackground:
Rise in awareness in DK about patient safety in 2000/2001
Project received support from:The Danish Ministry of the Interior and Health and County of Copenhagen
Impact: Project recommandation have been incorporated in the proposal for a new law in Denmark about adverse incident reporting and the support of learning systems
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Survey: Data collection (1:2)Doctors and nurses employed in all hospitals in
4 Danish Counties,Jan.- Feb. 2002Respondents recruited from
• University Hospitals of Copenhagen County (about 1/3) • All General Hospitals in 3 counties (nearly 2/3)
Major specialties included - distinguishable in data:• Anaesthesiology• Internal medicine• Orthopedic surgery• General surgery• Gynecology
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Survey: Data collection (2:2)
Number of questionnaires
Response rateDistributed Received
Actual scanned sample
Doctors 1537 711 703 46%
Nurses 2482 1320 1305 53%
Total 4019 2031 2008 51%
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The survey instrument: Adverse Events Questionnaire (AEQ)
1. Four casesUK case about disclosure to the pt; a near-miss incidenta mild outcome incident; and a severe outcome event
2. Models of reporting 3. Reasons for not reporting4. Patients’ requirements5. Reactions (pos/neg) towards staff from leaders 6. Attitudes to errors and factors impacting on
safety
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Three Models of Reporting
• Anonymity: reporter not known to anyone else – written, unsigned report
• Strict confidentiality: reporter known only to person(s) appointed as ”receiver”
• Limited confidentiality: identity of reporter known only to ”receiver”, but revealed to authorities if event involves ”gross negligence” or a crime
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ModelDegree of disclosure
Possibility of addtional
information about event
Possibility of feedback to
reporter
Anonymity: reporter not known
Name/identity unknown to everyone else
No additional information due to anonymity
No feedback due to anonymity
Strict confidentiality: reporter known only to ”receiver”
”Receiver” may not communicate name
Additional information possible
Personal feedback possible
Limited confidentiality: identity revealed if ”gross negligence”
”Receiver” may/must give away name/ID in ”severe” cases
Additional information possible
Personal feedback possible
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Which of the three models do you prefer? (p<0.001, Chi2)