Patients’ Rights in New Zealand: a tool for quality improvement?

1. Patients’ Rights in New Zealand: a tool for quality improvement? Ron Paterson NZ Health and Disability Commissioner March 2001

2. A window of opportunity to improve health services? HealthComplaints -

3. The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge Definition of Quality

4. Cervical Cancer Inquiry 1987-88 NZ Bill of Rights Act 1990 Human Rights Act 1993 Privacy Act 1993 Health reforms 1993 New Zealand Background

5. To promote and to protect the rights of health consumers and disability services consumers, and, to that end, to facilitate the fair, simple, speedy, and efficient resolution of complaints relating to infringement of those rights. Health and Disability Commissioner Act 1994

6. 10 Rights Services of an appropriate standard Informed consent Public and private sectors Proof of harm not necessary “Reasonable action in the circumstances” defence Code of Rights

7. Reasonable care and skill Compliance with standards Co-operation among providers to ensure quality and continuity of service. Right to good quality health care

8. Statutory cover for medical misadventure Bar on claims for compensatory damages Exemplary damages available but rare Impact of loss of tort deterrent? Medical Misadventure Compensation

9. Individual complaint Impact on individual provider Impact on overall quality of health care Improved health outcomes for population? Code as Quality Improvement Tool

10. Ambulance at bottom of cliff or Fence at top of cliff? Investigation reports as educational tool

11. To promote, by education and publicity, respect for observance of the rights of health consumers … Statutory goal

12. Patient deaths in Emergency Department Serious flaws in systems Poor supervision and training Need for credentialling Canterbury Health Report 1998

13. System to manage service quality National application and auditing Management responsibility Credentialling of medical staff

14. Systems failure in ED House surgeon in sole charge Inadequate guidelines Inadequate backup Taranaki Report 2001

15. Ministry of Health to review competencyand levels ofEmergency Department staff Recommendations from Taranaki Report

16. Investigation into: Operating theatre protocols PSA testing Patient care in ICU Quality assurance systems Incident reporting Gisborne HospitalReport 2001

17. No differentiation of near misses from adverse events System unclear to staff Response erratic Lack of feedback to staff Incident reporting system failures

18. Translating patients’ rights from slogans into effective regulatory levers for improving quality remains a major challenge. Policy implications