This was the first time I made a list of quotes of the research I had done. I still wasn't quite sure how to research or how to research for the articles that I needed. As a result, I feel that the research I did was not that effective. Because my research wasn't as effective, the evidence that I had and used for my Historical Conversations Project, was not as effective at proving and conveying my argument.

 

Challenges to Improving Patient Safety in NHS 

**NHS- National Health Services

•  The new deal from the European Working Time Directive, combined with national staff shortages, is threatening the standard of practice that trainees are likely to achieve. The UK has a doctor/patient ratio of 1.7/1,000 compared with 3‐5/1,000 in many European countries (Thorpe, 2002)
• The NHS has announced a cost of £4.5 billion for settling clinical negligence claims (National Audit Office, 2001) and has reported that 10 per cent of all hospital admissions are a direct consequence of adverse events. 
• Preliminary data revealed a sub‐optimal reporting rate of 27,000 incidents over nine months (Department of Health, 2002)
• A subsequent investigation identified problems with information technology as the predominant factor responsible for under‐reporting. 

• This is surely an over‐simplification, and premature launching of the project with inadequate training of users must have played a part. 

•  In an NHS which is knee‐high in debt, gaining additional resources is virtually impossible, and it is therefore not surprising that by March 2002 almost one quarter of NHS Trusts had failed to meet the basic risk management standards (Mayor, 2002).  (debt is reason for delayed improvement)

• Training reduces risks. Professional colleges maintain a level of competence through active supervision of training, while regulatory bodies such as the GMC assess the adequacy of these training programs.

• The UK has a doctor/patient ratio of 1.7/1,000 compared with 3‐5/1,000 in many European countries (Thorpe, 2002)

• Introducing shift work compromises training by limiting access to apprenticeship learning, continuity and educational opportunities (Catto, 2003)

• The Royal College of Child Health, rather than addressing the real issue of standards, has responded by redefining a “consultant” in an attempt to coerce juniors into senior posts. 

** locum- someone who does work of another person in place of another 

• Furthermore, trusts with financial pressures to comply with the Working Time Directive are employing an increasing number of locums, while non‐consultant career‐grade doctors are acting up as specialist registrars or consultants.
• Alarmingly, one survey reported that 5 per cent of trusts admitted that none of their staff‐grade doctors had postgraduate specialist qualifications (Gould, 2002)
• Faced with errors, doctors have traditionally relied on the “shame and blame” approach (Sharpe, 2000

• errors is based on the supposition that honest human error is inevitable,

• The NHS is a hierarchical system where the roles and responsibilities of individuals within each level are poorly defined but the final responsibility for an event or patient episode lies with an individual – the consultant.

• past disclosure has resulted in the blaming of individuals, with adverse consequences such as loss of reputation, temporary suspension and media smear campaigns

• whistleblowers”, despite legal protection from the Public Interest Disclosure Act, have remained quiet out of a sense of loyalty or fear of damaging careers.

• patient frustration is growing as demands are not being met. Within this environment, doctors fear that open disclosure of errors would intensify public negativity.

• In an Organisation with a Memory, the Department of Health urged doctors to include patients as active participants in their own care as a step towards improving patient safety 

• effective communication can prevent complaints and litigation (Lefevre et al., 2000; Vincent et al., 1994)

•  In recognition of this, communication skills are now a compulsory component of medical student training nationally, and they are assessed in doctors' appraisals.
• The same mistakes are occurring in different hospitals around the country because of the failure of health professionals to learn from their mistakes. 

• The process of “active learning” (i.e. learning through reflection and appraisal) is a powerful teaching tool, but not a new concept.

***CONC***

• Low morale and resentment are growing among health professionals as they face uncertainties with their training and working patterns and find themselves attracting criticism for conditions which are beyond of their control. Increasing tax subsidisation for an underachieving health system is orchestrating an increased number of complaints from a frustrated public. The Government exploits the NHS in the political arena, implementing patient‐centred health policies and actively boosting public expectations of the NHS, but without ensuring that adequate resources are available 

• there are improvements in risk management .

Daljit Kaur Hothi, (2004) "Challenges to improving patient safety in the NHS", Clinical Governance: An International Journal, Vol. 9 Iss: 3, pp.143 - 146

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Health Care in the 21st Century

•  envisioned a perfect health care system.

• today’s health care system is inefficient, highly costly, growing ranks of the uninsured, chasms in quality, and health care disparities. 

• health care spending in US is highest compared to any industrialized country, 15% of our GDP.

• current amount of health care per family is 9, 086(roughly 21% of the national median household income of $42, 409) a year and is rising

• life expectancy has increased from 47- 77 years

• yet there are troubling signs that we are not getting a good return on our investment.

• uneven access to healthcare, number of people without healthcare is rising

• quality of health care is not up to par to how much we spend

• According to a recent RAND study, Americans — even in the best of circumstances — receive only about 55 percent of the recommended care for a variety of common conditions

• There is also continuing evidence that health disparities exist on the basis of race, ethnicity, geography, and socioeconomic status.11-13 

• Moreover, as many as 98,000 people die each year in U.S. hospitals because of medical error 

• For example, it takes our physicians an average of 17 years to adopt widely the findings from basic research.15 The health care sector invests dramatically less — some 50 percent less — in information technology than any other major sector of our economy

• all Americans deserve the security of lifelong, affordable access to high-quality health care.

• we must acknowledge as a society that the current health care sectors cannot meet the needs of 21st-century America without a true transformation on the scale of what most of America's other industries sustained in the 1980s and 1990s as they retooled to become among the most competitive and successful in the world

• we must adjust our policies for a patient-centered, consumer-driven, and provider-friendly health care system

• ensure that patients have access to the safest and highest-quality care, regardless of how much they earn, where they live, how sick they are, or the color of their skin. Patients must be the first priority and the focus of the transformed system.
• The new system also must be responsive primarily to individual consumers, rather than to third-party payers.
• Government should provide people with adequate resources and promote the development of better information so that consumers can make informed choices.It must also provide a sturdy safety net with basic protections and additional assistance for the physically, mentally, or financially vulnerable.
• Electronic health records must contain all necessary health information, from medical histories to billing information; must be accessible from any Internet portal; must be capable of seamless use among all hospitals, doctors' offices, and clinics; and must be protected by strong, national privacy laws from inappropriate, unethical, or unauthorized use.Widespread adoption of electronic health records will reduce errors, improve quality, eliminate paperwork, and improve efficiency. Once fully implemented, electronic records will dramatically reduce cost and improve quality.
• To help drive the changes in the system, people should be more responsible for preventing illness and disease. 
• Health care must be affordable for all Americans. At the same time, cost-saving measures can go a long way toward improving health care quality and value and reducing waste and inefficiency.
• We should also take steps to make insurance more affordable and more consumer-friendly, particularly for individual consumers and small businesses. First, we must give individual consumers and small businesses more purchasing clout with state and regional purchasing pools and association health plans (commonly known as AHPs) 

Frist, William H., The New England Journal of Medicine, “Health Care in the 21st Century.” 20 Jan. 2005, Web. 20 Jan. 2016.

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Communication skills assessment in the final postgraduate years to established practice: a systematic review

• Communication breakdown is a factor in >50% of all postoperative complications, 70% of all medication errors and 80% of delays in treatment that resulted in death or permanent loss of function for patients.
• Physicians who provide information, spend more time defining patient expectations and solicit patient opinion tend to have fewer malpractice claims and higher patient satisfaction.
• In medicine, communication skills are thought to be acquired primarily by observation and by modelling, generally without formal feedback or formal assessment. Integrating communication skills into programmes has been attempted in many forms.
• Communication within the healthcare system is of vital importance and remains one of the main factors of potential error that threatens patient safety.
• From the 19 studies noted, there was no consensus on whether teaching communication skills actually improves communication, whether evaluation was purely objective or included self-evaluation.
• No definitive, validated tool to evaluate communication skills exists at the postgraduate level 
• Development of a validated tool is needed to progress standardised communication skills assessment at this level.
• The benefit of educational initiatives for improving communication skills cannot be demonstrated from the available literature.
• A defined standard of what constitutes acceptable communication skills needs to be defined.

Gills, Amy E, et al. Postgraduate Medical Journal. Communication Skills Assessment in the Final postgraduate Years to Established Practice: a Systematic Review.” 2 Dec. 2014, Web. 20 Jan. 2016.

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Relation between malpractice claims and adverse events due to negligence

• Our data suggest that the number of patients in New York State who have serious, disabling injuries each year as a result of clearly negligent medical care but who do not file claims exceeds the number of patients making malpractice claims.  
• The results of this study, in which malpractice claims were matched to inpatient  medical records, demonstrate that the civil-justice system only infrequently compensates injured patients and real identifies and holds health care providers accountable for substandard medical care. 

Localio, A Russell. "The New England Journal of Medicine. Relation Between Malpractice Claims and Adverse Events Due to Negligence.” 25 July, 1991. Web. 1 Feb. 2016.

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Claims, Errors, And Compensation Payments in Medical Malpractice Litigation

• Claims without merit were generally resolved appropriately: only one in four resulted in payment.
• portraits of a malpractice system that is stricken with frivolous litigation are overblown.
• Although one third of the claims we examined did not involve errors, most of these went unpaid. The costs of defending against them were not trivial.
• the malpractice system performs reasonably well in its function of separating claims without merit from those with merit and compensating the latter.
• Among the claims we examined, the average time between injury and resolution was five years, and one in three claims took six years or more to resolve.

Student, David M. The New England Journal of Medicine. “Claims, Errors, and Compensation Payments in Medical Malpractice Litigation”. 11 May, 2006. Web. 20  Jan. 2011 

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The Impact of Video Games on Training Surgeons in the 21st Century

• Past video game play in excess of 3 h/wk correlated with 37% fewer errors (P<.02) and 27% faster completion (P<.03).
• Current video game players made 32% fewer errors (P=.04), performed 24% faster (P<.04), and scored 26% better overall (time and errors) (P<.005) than their nonplaying colleagues.
• Video game skill correlates with laparoscopic surgical skills. Training curricula that include video games may help thin the technical interface between surgeons and screen-mediated applications, such as laparoscopic surgery. Video games may be a practical teaching tool to help train surgeons.
• A positive correlation was found between video gaming and visual attention processing, and a correlation with competence in analogous tasks was suggested.
• The participants were divided into 5 groups (after controlling for visual imagery abilities): 1 control group, 2 learning groups (with the intent to improve in actual putting), and 2 enjoyment groups (with the intent to simply enjoy the game). The results indicated that the 2 learning groups showed the most improvement in golf putting. All 4 of the experimental groups improved their posttest scores, demonstrating that video games can be an effective skill transfer tool, even without haptic references, particularly if a user is engaged in a skill-learning strategy
•  Over-the-counter video games may constitute a training resource, not as simulation but as a gradual path of analogous or parallel skill acquisition.

Rosser Jr.,  James C., et al, JAMA Surgery. “The Impact of Video Games on Training Surgeons in the 21st Century. 01 Feb. 2007. Web. 20 Jan. 2016.

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We have to Operate but let’s play first

• Doctor James Clarence Rosser Jr., laparoscopic surgery
• He keeps an Xbox, along with PlayStation 2 and GameCube consoles, just a few strides from the operating room so he can warm up with a favorite, Super Monkey Ball, just before surgery 
• Last year Dr. Rosser was a co-author of a study that concluded that surgeons who played video games for at least three hours a week were 27 percent faster and made 37 percent fewer mistakes than surgeons who did not play video games.
• Mr. Menache and Dr. Rosser said they are working with Sony Pictures to use even more advanced radio-frequency motion-capture techniques to gather the precise movements of doctors in surgery.
• As video games evolved, so did Dr. Rosser's understanding that there may be useful correlations between skills he acquired with a joystick and skills he began to acquire in medical school.
• These days, however, Dr. Rosser said he was helping to turn out increasing numbers of young doctors who not only show promise in becoming excellent laparoscopic surgeons, but more than a few who can play a mean game of Super Monkey Ball.
• "We're going all over the world training people, trying to give them the skills that seems like I was able to nurture with video games," Dr. Rosser said. "I have a video-game training course that I invented trying to trick these doctors into learning new tricks.”

Marriott, Michel. New York Times. “We Have to Operate, but Let’s Play First.” 24 Feb. 2005. Web. 2 Feb. 2016.