Lessons Learned from a Systems Approach to Engaging Patients and Families in Patient Safety Transformation.

BACKGROUND: Effective patient- and family-centered care requires a dedication to engaging patients and family members in health system redesign to improve the quality, safety, and experience of care. Provided here are lessons learned six years after establishing an infrastructure of patient and family advisory councils (PFACs) focused on improving health care quality and safety. CONTEXT: A large regional health care system with multiple hospitals and ambulatory care delivery sites in the eastern United States adopted a systemwide approach to Patient and Family Advisory Councils on Quality and Safety (PFACQSⓇ) in 2012. APPROACH: This conceptual article describes the barriers and facilitators of adopting, implementing, and sustaining the PFACQS model across a large, geographically diffuse health system. Successful strategies that emerged include active board engagement, co-creation and mentorship by experienced patient advocates to support enhanced engagement by local PFACQS community members, and clear alignment with and line of sight on organizational quality and safety goals. CONCLUSION: Implementing a robust network of PFACQS focused on improving quality and patient safety requires leadership commitment to transparency, as well as mutual respect and trust. Establishing clear guidelines, structures, and processes supports early adoption. Openness to continuous improvement and adaptations are important to program success and contribute to program sustainability.

Teaching medical students the art of medical error full disclosure: evaluation of a new curriculum.

BACKGROUND: Despite the acknowledgment that error disclosure is essential to patient safety and the patient-provider relationship, there is little undergraduate training related to error disclosure. DESCRIPTION: Pilot test and evaluate an educational module designed to improve student confidence in understanding and performing medical error disclosure. The training was designed to establish competency in the four Rs of apology-recognition, responsibility, regret, and remedy-and included a 3-hr interactive discussion, training DVDs, practice of full disclosure using standardized patients, and facilitated reflection. Students were assessed pre and post using a self-administered confidence survey. EVALUATIONS: Confidence among students improved significantly from 11.5 +/- 2.9 before to 15.3 +/- 1.3 after the module (p <.0001). CONCLUSIONS: The full disclosure educational module significantly improved students' perceived confidence in admitting medical errors and their confidence in understanding and performing the full disclosure of a medical error.