All physicians pledge to "do no harm" and are dedicated to the
proposition that even one medical error is one too many. A
commitment to a culture of patient safety involves all members of
the health care team: physicians, hospitals, nurses, other
practitioners, even patients themselves and their families. Health
care today involves so many interdependent, moving parts,
especially for the sickest and most severely injured patients. We
must continue to devise systems that prevent small, unintentional
mistakes from quietly and rapidly turning into irreversible,
destructive forces. We must ensure that all members of the team
possess the knowledge, skills, training, and experience to carry
out their assigned tasks. We must do all we can to ensure that our
patients, whenever possible, leave the health care system healthier
than when they came in.
Texas health care professionals must support an environment
conducive to reporting preventable errors and developing strategies
to prevent and correct them.
There is, and always has existed, a strong consensus in the
medical community on how to continuously minimize the potential for
human error in our vast and complex medical delivery systems. The
rigors of the scientific method hold the key to identifying and
correcting the circumstances that erode patient safety. All members
of the numerous interdisciplinary health care teams - physicians,
nurses, hospital administrators, and other professionals - must
collaborate in this process.
Media coverage of the 1999 Institute of Medicine (IOM) report,
"To Err is Human: Building a Safer Health System" implied that
patient safety is not a priority concern of physicians and other
health care professionals and that the report raised new issues for
the medical profession. Despite the report's methodological flaws,
medicine can be thankful that it brought new resources to the
battle. Physicians and hospitals have been addressing this
challenge for decades and have made tremendous progress in
improving patient safety. It is remarkable that they have been able
to reduce medical errors at all of late, in the face of the
cost-cutting onslaught of government and managed care.
Modeled after the aviation industry's nonpunitive reporting of
error, physician-led teams have systematically identified the root
causes of unintentional errors, devised and implemented system
changes that correct these problems, and shared their results with
their peers. All of this has taken place, and must take place, in a
no-fault environment in which the goal is to fix the problem, not
fix the blame. Confidentiality protections for patients, health
care professionals, and health care organizations are essential if
we are to learn about errors and effect change. Information
developed in connection with reporting systems should be privileged
for purposes of federal and state civil matters and administrative
Errors of omission - such as not prescribing certain medications
for patients with certain conditions - are less visible, easier to
correct, and have a greater long-term impact on patients' health
than errors of commission - such as operating on the wrong limb.
The most important work for physicians lies in developing and
promoting evidence-based guidelines for patient care and
discouraging their colleagues from using those practices that do
not comply with these guidelines.
TMA President Robert T. Gunby Jr., MD, appointed a Select
Committee on Patient Safety to develop recommendations regarding
patient safety legislation and to lead TMA's participation in the
Institute of Health Care Improvement's 100,000 Lives Campaign. The
select committee is focusing on concrete ideas to reduce adverse
outcomes and decrease risks to patients. These include efforts to
reduce surgical infections and adverse drug reactions, and to
improve the use of proven practices, such as administering aspirin
and beta blockers to heart attack patients. Best practices need to
be disseminated among physicians and other health providers.
Since 2003, hospitals, ambulatory surgical centers, and mental
hospitals in Texas have been required to report certain "sentinel
events" to the Texas Department of State Health Services (DSHS)
annually. The agency is responsible for aggregating data for public
release, but the hospital names remain confidential. Facilities
must perform a root cause analysis and develop a corrective action
plan within 45 days of any event.
A new federal law, Patient Safety and Quality Improvement Act of
2005, has created a voluntary and confidential system for medical
error reporting and is a major step forward in improving patient
care. TMA is evaluating whether additions or changes at the state
level would allow information to be gathered without the threat of
liability so that systemic patient safety problems can be
identified and corrected.
To enhance efforts to improve safety, TMA recommends:
Encouraging all Texas hospitals, physicians, health care
facilities, and other practitioners to endorse the principles
of the Institute of Health Care Improvement's 100,000 Lives
Campaign and to implement them wherever possible.
Creating patient safety organizations under the Patient
Safety and Quality Improvement Act of 2005 to collect
voluntarily reported medical errors, incidents of "near
misses," and enhanced health care quality practices.
Developing a non-punitive, confidential culture for
reporting health care errors that focuses on preventing and
correcting systems failures and not on individual or
Enhancing patient safety education in medical school and
A strong and fair Texas Medical Board must protect the public
safety while it brings new Texas physicians into clinics, exam
rooms, and hospitals as quickly as possible. Limited-license health
care practitioners must practice within the arena safely defined by
their knowledge, skills, training, and experience.
The Texas Medical Board (TMB) continues to expand and improve its
operations after the 2005 sunset review and the extensive changes
to the Medical Practice Act the legislature adopted with TMA's
strong support in 2003. Those changes further protect the public
health from physicians who practice below the standard of care, and
provide due process protections for physicians under investigation.
The board received new legal tools and additional financing to hire
more and better staff. The legislature must continue to monitor how
well the board has instituted those changes.
All Texans must be confident that their physicians are
qualified, competent, and uphold the highest ethical and
professional standards. All Texas physicians must be confident that
their fellow physicians are qualified, competent, and uphold the
highest ethical and professional standards.
To protect the public safety, TMA recommends:
Ensuring a strong and well-funded TMB and extensive
evaluation of the physician disciplinary process. This includes
expediently and accurately processing licensure applications as
well as affording due process to both complainants and
Subjecting physician testimony in health care liability
cases to TMB scrutiny because that testimony constitutes the
practice of medicine.
The scope of practice of health care professionals must be limited
by their education, training, and skills. This is a patient safety
issue. In virtually every legislative session, one or more groups
of nonphysician health care professionals seek to expand their
scope of practice, oftentimes under the guise of increasing access
to care. Nonphysician health practitioners are highly valued by the
medical profession; physicians and allied practitioners care for
patients on a daily basis working as a team. However, only
physicians should exercise independent medical judgment, serving as
the trusted leader of the health care team.
To protect patients, TMA recommends:
Stopping any efforts to expand scope of practice beyond that
safely permitted by an allied health practitioner's education,
training, and skills.
Goal 5: Humane and Cost-Effective End-of-Life