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On location: Trinidad

MPS presented at an important medicolegal event in Trinidad in January. Dr Brian Charles, consultant for MPS, reports on some of the lessons learned

Presenters from both sides of the Atlantic and the Caribbean region descended on Trinidad in January for a conference on the aspects of quality relating to healthcare. The conference, Improvement in Health Care Quality and Delivery: Making A Difference, was hosted by the University of the West Indies’ Faculty of Medical Sciences, and took place at the university’s St Augustine’s Campus.

The objectives of the conference were to bring together various stakeholders (both private and public sectors) in one forum, in order to assess the current state of healthcare quality and its delivery in the region, and share ideas on how to improve it.

These ideas included the role of IT in bringing added value; the use of independent assessment/ audit of institutions; and placing a strong focus on risk management and a patient’s charter. 

There were also a number of sub-themes sprouting off the main agenda:

  • Models of healthcare quality and delivery (local, regional and international)
  • Healthcare access, quality and insurance
  • Needs assessment of healthcare institutions
  • Risk management
  • Quality care and health tourism
  • Information technology and healthcare quality
  • Quality care and critical medicine (ICU and emergency settings)
  • Sustainable quality care
  • Quality care and professional development
  • Quality care and communication
  • Quality care and medical education (universities/tertiary learning institutes).
Procedures as simple as improving efficiency in transporting lab samples may have huge benefits to the end results for patients as well as their satisfaction

Dr Fuad Khan, Minister of Health, opened the conference, and spoke about the importance of systems and audit in the local Trinidad health sector. He highlighted how procedures as simple as improving efficiency in transporting lab samples may have huge benefits to the end results for patients as well as their satisfaction. He also spoke of the relationship between staff behaviour and patient satisfaction.

The feature address was given by Sir Andrew Cash, Chief Executive of Sheffield Teaching Hospitals Trust in the UK, titled “International Models of Health Quality – Lessons Learnt over the Years”. In a humorous account of how quality can be achieved in difficult circumstances and limited resources, Sir Andrew gave many examples of how the emphasis on quality has changed over the years in the UK. He stressed that like the rest of the world, improved quality must be achieved with less financial resource.

Dr Brian Charles of MPS then presented on “How Risk Management Can Contribute to Better Healthcare”. Dr Charles covered the basic tenets of risk and outlined the cost to the health sector when these risks escalate to adverse events.

Using published data, Dr Charles then demonstrated the benefits of risk management programmes in terms of decreased average cost per lawsuit, fewer lawsuits, and decreased lawsuit resolution time.

Effective risk management: the components 

  • Diagnosis
  • Identification of risk or potential risk
  • Assessment 
  • Probability calculation of adverse outcomes from the risk situation
  • Prognosis
  • Estimation of the impact of the adverse outcome
  • Management and control of the risk.

An element of re-evaluation of the risk management efforts should also be included. Risk management programmes must encompass the entire organisation but should be led and accepted by the administration. All staff ought to be involved in the reporting process so that diagnosis and identification of all adverse incidents is as comprehensive as possible.

Making change in the third world

There are several factors in developing third world countries that restrict easy implementation of risk management programs. These include demonstrating value (how can you quantify what doesn’t happen because it was prevented?), our shame and blame culture – which results in underreporting – fear of persecution/ victimisation, and improper documentation. Financial resources are also a concern.

Focused programmes in risk management will ultimately result in increased patient satisfaction, decreased complaints and law suits, decrease cost from preventable errors, and overall improvement of the standards of healthcare. MPS hosted a booth providing literature on the MPS programmes, demonstrations of the educational materials and e-learning platforms. Ms Donna Miles proved a valuable resource for the conference participants.
Focused programmes in risk management will ultimately result in increased patient satisfaction

Donna Miles: your MPS representative

As MPS representative in Trinidad & Tobago, I hosted a booth that was situated in the reception/registration area of the conference. This was an excellent position for showcasing MPS and the booth attracted many of the participants.

There was ample literature for the delegates and many had questions on corporate indemnity and public sector coverage. Members were also pleased to see that MPS was involved in the conference and hoped that this would continue.

Over the last six years I have worked with organising membership, doing presentations to medical and dental students, speaking to junior doctors at Mt Hope and San Fernando General Hospitals, and organising MPS visits. Recently this has extended to discussions on corporate membership in the region, which will hopefully bear fruit in the near future.

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