Saturday, September 12, 2015

Interprofessional education; some research in progress

Building a Safer Health System (2000) documents risks associated with adverse events in hospitals in the USA. Such adverse events are not new. In 1976 Illich named such adverse events as iatrogenesis, the preventable harm that people experience in association with health practitioners. In a New Zealand study, Davis, Lay-Yee, Bryant, Scott, Johnson, and Bingley, (2002) reported an iatrogeneic rate 12.9% for those hospitalised. This involved a retrospective study of documented incidences across 13 NZ hospitals. The undocumented adverse event rate can be presumed to be much higher.

Evans (2007) reified the staggering size of these preventable events by providing the following provocative illustration: These 1500 deaths are equivalent to four Boeing 747’s crashing in New Zealand every year, a rate that is three times the road traffic death rate, and double the deaths from both homicide and suicide (Evans 2007, p. 16).[Computer generated photo of the collision. Photo/wikipedia.org]
This study set out to investigate the concerns raised with regard to communications being implicated in the preventable harm caused by health practitioners in New Zealand in current times. The safe provision of health and disability services in New Zealand is overseen by the Office of the Health and Disability Commissioner(HDC).


Miscommunication is a significant contributor to iatrogenesis in healthcare practice in New Zealand.

In studying this, our analysis of complaints made to the HDC (100 complaints lodged with the HDC between February 2012 and May 2014) we found miscommunications implicated in 99 out of 100 case notes reviewed. Of particular note expanding on earlier research into communications related iatrogenesis is the multi-model nature of health related communications in current times. One third of the cases analysed involved technologically mediated communications, these included telephone calls, text messaging, faxed communications, and computer mediated communications such as emails.
However, while the technology is recognised as having influence, miscommunications do not occur in any of the reported discussions and case notes without there also being human involvement. While media representation tends to conflate what is new with also being causative, this is an attribution error.

Our findings provide irrefutable evidence of the need for healthcare practitioners to have well-developed interpersonal communication skills. The analysis also identified the need for health practitioners working with emergent technologies to understand how these technologies enhance or hinder practice. Of further significance is the amount of error that occurs involving communications between health practitioners.


Conclusions: As has been previously reported in the literature, the incidence of miscommunication within the health sector remains a serious and critical concern, one implicated in preventable deaths, as well as in the development of significant and ongoing disability, delays to treatment and the development of needless distress.
What is reported on here is an uncomfortable truth. However, there is scope to alter how communications are taught and learned by health professionals. Shifting the acquisition of communication skills from mastery of content to instead sharing a common skill set and practicing these inside of processes where we as health professionals learn to talk with each other,is but one step forward on this much needed path. This argument supports providing greater opportunities for interprofessional education, of having diverse groups of health professionals learning with and from each other rather than within siloed curricula.


References

Davis, P., Lay-Yee, R., Briant, R., Ali, W., Scott, A. J., & Schug, S. (2002). Adverse events in New Zealand public hospitals I: Occurrence and impact. The New Zealand Medical Journal, 115(1167).
Evans, S. (2007). Silence kills--challenging unsafe practice. Kai Tiaki: Nursing New Zealand, 13(3), 16-19.
Illich, I. (1976). Limits to medicine; Medical nemesis: The expropriation of health. London, England: Marion Boyars.

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