Preventing errors in clinical practice: a call for self-awareness

While ascribing medical errors primarily to systems factors can free clinicians from individual blame, there are elements of medical errors that can and should be attributed to individual factors. These factors are related less commonly to lack of knowledge and skill than to the inability to apply the clinician's abilities to situations under certain circumstances. In concert with efforts to improve health care systems, refining physicians' emotional and cognitive capacities might also prevent many errors. In general, physicians have the sensation of making a mistake because of the interference of emotional elements. We propose a so-called rational-emotive model that emphasizes 2 factors in error causation: (1) difficulty in reframing the first hypothesis that goes to the physician's mind in an automatic way, and (2) premature closure of the clinical act to avoid confronting inconsistencies, low-level decision rules, and emotions. We propose a teaching strategy based on developing the physician's insight and self-awareness to detect the inappropriate use of low-level decision rules, as well as detecting the factors that limit a physician's capacity to tolerate the tension of uncertainty and ambiguity. Emotional self-awareness and self-regulation of attention can be consciously cultivated as habits to help physicians function better in clinical situations.     

The changing healthcare workforce: a call for managing diversity

It's 2000. Walk into a department of a typical healthcare organization. Of the 14 employees, four are African-American, five are Hispanic, three are Asian, and two are white. Seven are women. For at least half of the group, English is a second language. Are you willing to teach English to improve service to patients and internal customers? How much training is your organization willing to provide? What impact does diversity have on productivity? And thinking more globally, how does your organization move from a number-crunching affirmative action posture to a workforce that reflects its patients and society?     

Allied health representation: a call for action

The Coalition of Allied Health Leadership (CAHL) 2000 Representation Team sought 1) to secure Federal advisory appointments for allied health professionals and 2) to connect allied health representatives with Federal advisory committees, councils, boards, and other deliberative bodies. Among the deliberative bodies providing recommendations on a broad range of issues to the President of the United States and the Executive Branch, there are over 1,000 advisory committees, councils, and boards, with more than 20,000 members. Recommendations made by the deliberative bodies include those related to health care. The literature and Web sites reveal allied health professionals have little or no representation on the bodies that represent allied health professionals and their constituents. These findings provide insights into Federal-level deliberative bodies to which allied health professionals have access or on which they warrant representation. This article reports background information, including the CAHL 2000 Representation Team objectives; an overview of federal advisory committees; recommendations for gaining access to deliberative bodies and active participation in fulfillment of Healthy People 2010 goals; and continued commitment to such representation by the CAHL and allied health professionals.     

Preventing medical errors: communicating a role for Medicare beneficiaries

This study used a focus group methodology to examine how Medicare beneficiaries reacted to messages on specific kinds of preventive action, including those adopted by public and private section health organizations. Beneficiaries were asked to rank the messages on their own, and then to discuss their rankings in focus groups. The best-received messages advocated a collaborative patient-provider relationship. They also specified which actions to take, and how to implement them. The authors conclude that public health campaigns to reduce errors need not undermine trust in providers.     

The Safe Motherhood Initiative: a call for action

An official call for action was issued at the end of the conference on Safe Motherhood held in Nairobi, Kenya, in February 1987. The conference was organized to draw attention to the half million maternal deaths that occur each year. Women in developing countries run 50-100 times the risk of dying in pregnancy or childbirth than their counterparts in developed countries. There are only 2.9 maternal deaths/100,000 live births in developing countries compared to 300-1000 maternal deaths/100,000 live births in developing countries. Illegal abortion from unwanted pregnancies accounts for 25-50% of these deaths. The causes of maternal mortality are rooted in the adverse social, cultural, economic, and political environment women face in the Third World. These causes must be addressed if women's health and status are to be improved in the long term. On the other hand, there is an immediate need for low-cost, effective interventions that can have a major impact on reducing mortality and morbidity from obstructed labor, hemorrhage, toxemia, infection, and complications of abortion. A political commitment must be generated to reallocate resources so that maternal mortality can be reduced by 50% in 1 decade. Needed is an integrated approach to maternal health care that makes it a priority within the context of primary health care services and overall development policy. Women need to be involved in planning and implementing programs and policies to ensure that their needs and preferences are taken in account. In addition, family planning and family life education programs need to be expanded and made socially, culturally, financially, and geographically accessible. These activities need to involve both governments and take advantage of the flexibility, responsiveness, and creativity of nongovernmental organizations.     

Women's health theorizing: a call for epistemic action

The women's health community is challenged by global social and economic pressures. In order to ensure the salience of their empirical and theoretical research, women's health researchers are struggling with an analysis of what has successfully typified women's health and a critical awareness of the pressures that will mark its future. For many researchers, this has provoked a quest for new women's health paradigms to inform and spur action regarding the future of women's health. Re-theorizing women's health cannot be successful in the absence of an analysis of the epistemological orientation of women's health research. However, little has been done to examine these epistemological roots. This paper examines the historic epistemological foundation of women's health research in order to facilitate an understanding of the theoretical and conceptual underpinnings of women's health. This review is intended to guide future epistemic action necessary to advance the field of women's health research and highlight current efforts that may support work in this field.     

The future of medical education: a call for action

The challenge of building new medical schools or expanding the class size of current ones is a lengthy and costly enterprise. That reality argues for the creation of a national vision about how to proceed and what to prioritize, a vision that could serve as a map for public and private officials considering further investment in medical education. A national commission funded by one or several health philanthropies is suggested as an expeditious vehicle to focus this discussion and move the debate forward. Instructive educational innovations in osteopathic and nursing education are suggested as germane to the deliberations of a national commission, as are creative means of student funding.     

Scarce physicians encounter scarce foundations: a call for action

The United States is in the early phases of a deepening shortage of physicians, a situation last experienced fifty years ago. As then, energy and creativity will be needed to meet the nation's needs, and U.S. philanthropic foundations will again be called upon to play leadership roles. The issues are broad--extending from medical education to regulation and from building new schools to recruiting more international medical graduates. Throughout these issues, foundations are uniquely positioned to convene stakeholders, fund analyses, foster new medical education paradigms, and support the growth of its infrastructure. Foundations will be necessary partners in what is to come.     

Representation: a call to action for allied health professionals

The Coalition of Allied Health Leadership (CAHL) Representation Project committee examined the representation of allied health professionals in political and other policy-making groups and found it both fragmented and lacking. The benefits to individuals participating in such groups, as well as to the allied health profession as a whole and to the groups themselves, are described. Individuals are urged to participate, and the means to do so are presented.     

Ambulance services: clarion call for action

Ambulance transport is scarce and expensive but there are many ways in which it can be used more economically. Alison Norman, assistant secretary, National Corporation for the Care of Old People, poses some questions about service abuse.