Medicine in the 20th century seemed to have achieved many of its goals due to the vigorous efforts of healthcare providers to learn and to apply scientific knowledge and advanced medical technology. In the United States, however, the Institute of Medicine (IOM) has estimated that about 44,000 to 98,000 patients have suffered avoidable deaths during their hospital stay every year. This fact suggests that, despite the significant medical advancements of the last century, there remains significant room for improvement in the field of patient safety.
There are many organizations throughout the world that promote patient safety. In Japan, organizations such as the Japanese Society for Quality and Safety in Healthcare and the Japan Council for Quality Healthcare Patient Safety Promotion Committee are actively sharing information and hosting seminars in efforts to further enhance patient safety practices.
It is a well-known fact that the medical society has exerted tremendous efforts to ensure proper risk management in its field. Cardiopulmonary resuscitation training, for example, has been widely provided as a means of improving medical risk management by improving the treatment of patients suffering in-hospital cardiac arrest. The number of JAAM (Japan Association for Acute Medicine) -accredited ICLS (Immediate Cardiac Life Support) trainees has now reached 180,263 since April 2003, and the Japan ACLS (Advanced Cadiovascular Life Support) Association reports that more than 200,000 people have been trained since its establishment 9 years ago. In spite of spending such enormous resources to provide cardiopulmonary resuscitation training, the improvement in the number of patients who leave the hospital alive after in-hospital cardiac arrests remains low. This suggests that conventional training methods will only achieve level 1 (Reaction) or 2 (Learning) of the Kirkpatrick’s four-level evaluation model, with much less success likely at level 3 (Behavior). To our disappointment, it seems unrealistic to expect level 4 (Result), the achievement of any measureable improvements in patient safety in this endeavor.
The report from The Japanese Medical Investigative Commission of Malpractice (JMICM) (Iryo Jiko Chosakai, Yao, Japan) estimates that 30,000 to 40,000 patients lose their lives annually due to medical malpractice in Japan, but there are no details about the patient safety circumstances, leaving plenty of controversies in the IOM report. There is an organization overseas promoting patient safety by measuring various patient safety indices. Recently, the WHO (World Health Organization) has started to promote student training in patient safety education applying improvement science and PDSA (Plan-Do-Study-Act) cycle. Patient safety promotion should be linked with detailed evaluation in Japan, as well.
Patient safety has not been adequately advanced by traditional means of information sharing and training activities. Possible reasons include:
In order to solve these problems, we have founded the Japan Patient Safety Foundation for Organizational Culture and Learning System (JPSOCLS) and initiated a project to support the practice and research of patient safety, not only in Japan but globally. We are planning to provide solutions to the problems described above as follows:
This world is being faced with not only patient safety issues but also the aging of its population. Through the activity of the JPSOCLS, we plan to develop a learning management program for home healthcare organizations integrated with the promotion of patient safety. The experience in Japan, as a society aging more quickly than any other country, will definitely contribute to the improvement of Asian and global home healthcare systems with integrated patient safety activities and change the traditional practices of the healthcare system.