Wednesday, April 13, 2011

Progress and Pain: Stories from the International Forum

(Editor's note: H&HN Daily Regular Contributor Emily Friedman is guest blogging today.)

AMSTERDAM—Last week, I had the privilege of speaking at the International Forum on Quality and Safety in Healthcare in Amsterdam, Netherlands, cosponsored by the Institute for Healthcare Improvement and the British Medical Journal (BMJ) Group. There were nearly 3,000 attendees from 86 countries; several thousand more watched via satellite.

Rein Willems, the retired president of Shell Netherlands, now a member of the Dutch Senate, in his keynote address spoke of "blame-free error reporting"—systems that allow or require reporting of all adverse events, without blame or penalty—and asked why health care systems are so reluctant to adopt this approach when it is used widely in other sectors. Americans might say that the reluctance is due to potential malpractice litigation, but it's a problem in health systems around the world, including those where lawsuits aren't much of an issue.

Two compelling sessions focused on disaster. Afghan physicians spoke of progress made despite years of Taliban oppression and war. Dr. Nadera Hayat Burhani, deputy minister of health, emphasized culture change: "We need to break learned helplessness on the part of [hospital] staff." She also reported that Afghanistan has gone from relatively few midwives to 2,000 (critically important in a country with the second highest maternal mortality rate in the world), and that 22,000 community health workers have been trained. The most moving moment came when Dr. Nasrine Oryakhail, director of Malalai Hospital in Kabul, marveled that ten years ago, she could not leave her home without permission, and now she was addressing an international audience.

A Skype broadcast of two physicians in Fukushima Prefecture, Japan—the center of earthquake, tsunami, and nuclear power plant damage—was riveting. Dr. Ryuki Kassai, a community physician and professor, and Professor Shigeatsu Hashimoto of Fukushima Medical University Hospital (FMUH) said that the hospital did not suffer structural damage, but its water and electric supplies are severely limited.

Five hospitals were destroyed by the quake and tsunami; their patients were transferred to FMUH, as were patients from a hospital near the power plant. FMUH is screening transferred patients, local residents, and plant workers for radiation exposure. About 500 have been screened; 10 were decontaminated, and two nuclear plant workers who suffered burns from highly radioactive water were treated. FMUH also brought in an expert on radiation risk from the Nagasaki University School of Medicine to educate staff and counteract rumors.

Dr. Kassai and Dr. Hashimoto expressed their thanks for words of support and prayers from around the world, which, they said, encouraged them and their colleagues to persevere.

"Please think of us," Dr. Kassai said.

The BMJ has made the broadcast from Japan available on its web site.

Emily Friedman

Independent Health Policy and Ethics Analyst


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