Editor’s Notebook
September / October 2010
Editor’s Notebook
The Patient Safety Kaleidoscope
I’m increasingly aware that some communities are underrepresented in the patient safety movement. I’ve come to that awareness through various organizations, events, and articles (for which I provide links in the online version of this article, at http://psqh.com/september-october-2010/602-editors-notebook.html).
In late August, I attended Engaging Minority Communities in Safer Care. The workshop was sponsored by MITSS (Medically Induced Trauma Support Services), the New England Regional Black Nurses Association, and the National Association of Hispanic Nurses, and was held at Roxbury Community College, near Boston. The program featured presentations and small group discussions with attendees representing a range of ethnic and racial backgrounds as well as different roles in healthcare, including clinicians, administrators, community organizers, mediators, educators, and consumers. We discussed how to reach minority communities, the emotional impact of harm due to medical errors, and the effect of cultural sensitivity or lack thereof on the quality of care. In reflection and conversations since then, I have developed an appreciation for dimensions of patient-centered care and safety that are new to me.
I usually think about patient-centeredness at the point of care: clinicians who communicate effectively with patients, supply information that is accessible, provide a respectful environment, and encourage patients and their families to ask questions when they don’t understand, speak up when their concerns have not been addressed, and to question treatment options not consistent with their values. This patient centeredness must include accommodation for disabilities and cultural variations such as language, race, ethnicity, and gender.
I’m beginning to understand that for meaningful improvement of safety and quality, acceptance of our differences must not be limited to the point of care: exam rooms, emergency departments, or even Patient Advisory Boards. Our cultural competency must extend into community settings and reach people in their daily lives, with education, but first with sincere listening.
This new learning emerged as I processed my thoughts following the workshop. I attend lots of conferences and enjoy feeling stimulated and satisfied after a content-rich day. This was a little different; in addition to information, the day was filled with personal stories and emotion. I’ve worked hard to synthesize my ideas and experiences from the day. The program was well organized, but my impressions are more kaleidoscopic than linear.
Talking with one of the organizers helped me gather my thoughts. Deb Washington, RN, PhD(c), director of diversity for patient care services at Massachusetts General Hospital, pointed out that we need to learn from people about their healthcare experiences by going to their communities and offering to listen to their stories as they’d like to tell them. Harvesting the richness of personal stories takes time. So often, in traditional medical settings, we’re anxious to get to the point and stay on schedule. Clinicians feel increasing pressure to race the clock. It’s not clear how best to reach out to people in communities—the solutions must be practical and varied—but one way or the other, it’s crucial to give them sufficient time and attention.
As we continue to improve patient-centeredness, I hope we can include community dialogue as a strategy. The workshop organizers plan to develop a model that will help foster those conversations, which I’ll report on here and at www.psqh.com.
Please stay tuned!
Resources
Medically Induced Trauma Support Services www.mitss.org
New England Regional Black Nurses Association www.nerbna.org
National Association of Hispanic Nurses www.thehispanicnurses.org
International Medical Interpreters Association www.imiaweb.org
National Council on Interpreting in Health Care www.ncihc.org
National Conference Series on Quality Health Care for Culturally Diverse Populations www.DiversityRXConference.org
Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals www.jointcommission.org/PatientSafety/HLC/HLC_Develop_Culturally_Competent_Pt_Centered_Stds.htm