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Accountability: To Whom? For What?

Accountability: To Whom? For What?. Lucian L. Leape, MD Harvard School of Public Health 10 th Anniversary of To Err is Human The Commonwealth Fund and Alliance for Health Reform March 17, 2010, Washington, DC. Accountability today . Blame and punish – Who will be fired?

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Accountability: To Whom? For What?

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  1. Accountability: To Whom? For What? Lucian L. Leape, MD Harvard School of Public Health 10th Anniversary of To Err is Human The Commonwealth Fund and Alliance for Health Reform March 17, 2010, Washington, DC

  2. Accountability today • Blame and punish – Who will be fired? • Mandatory reporting – Serious Reportable Events • No pay for Serious Reportable Events

  3. Accountability today – what’s wrong • Retrospective – after the patient has been harmed • Blame and punishment all over again Safety is about prevention - prospective We don’t want to hold people accountable for hurting people, we want to hold them accountable for NOT hurting people

  4. A shared vision of what health care can be • Provided by an organization that is responsible for all the health needs of a population • Care that is evidence-based, patient-centered, safe, timely, efficient, and equitable • In an environment that is transparent, non-punitive, supportive, but accountable • By caregivers who are competent, compassionate, and collaborative, and share a sense of responsibility

  5. Prospective Accountability • Individual • Institution • Regulator

  6. Prospective Accountability • Individual • Technical competence – keeps up • Social competence – respect, empathy, collaboration • Accountable – follows safe practices, works to improve • Institution • Regulator

  7. Prospective Accountability • Individual • Institution • Provides a safe, non-punitive environment – a “just” culture • Implements all known safe practices • Provides the resources and training needed • Monitors practices • Monitors performance • Takes corrective action when needed • Regulator

  8. Prospective Accountability • Individual • Institution • Regulator • Sets standards for practice and performance • Safe practice – NQF list • Environment, working conditions • Credentialing • Worker safety • Monitors compliance • Sanctions when necessary

  9. Reciprocal Accountability Regulators Hospitals Professionals

  10. Reciprocal Accountability Regulators Patients Hospitals Professionals

  11. Do we need a Federal Patient Safety Agency?

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