Law protects physicians with patient safety plans

Many primary care physicians in Washington state operating in small group practices now have the same rights as hospitals to learn from mistakes without fear that those lessons will be used against them.

Practices with as few as five licensed health care professionals can now establish Coordinated Quality Improvement Programs to review negative outcomes, injuries, infection controls and quality improvement strategies. The information these programs develop will be protected from legal discovery and can be shared with different organizations.

Hospitals and larger practices were granted this right in 1993, but the law was amended this year to include smaller practices. The Washington State Medical Assn. -- at its annual meeting last month -- voted to make implementation of the law as "broad and effective" as possible.

"It's just another step in trying to accomplish two things: Encouraging more physicians to get involved in patient safety, and to share information about what we can do to continually evolve a better culture of safety," said WSMA Director of Professional Affairs John Arveson. "That's what we're after -- Getting the entire profession to adopt and internalize a culture of safety."

There was some initial confusion that the new law applied to practices with as few as five physicians, but Pattie Rathbun, health policy development coordinator with the Washington Dept. of Health, said licensed nurse practitioners, nurses, physician assistants and others can be included in the total.

Washington's new state law has already attracted some national attention. Mark Krafton, executive director of state and external relations with the Joint Commission on Accreditation of Healthcare Organizations, praised how the law extends to physician offices the same protections hospitals have to examine adverse events and find their root causes.

"That kind of critical self-analysis works best when there's an understanding that the actions and deliberations are not subject to disclosure and people can be as candid and open as possible," he said. "Another key element of the law is that it now allows these physician practices to communicate information to other organizations such as hospitals."

"Good first step"

Hugh Straley, MD, a Seattle-based oncologist who chairs the Washington Patient Safety Coalition's steering committee, said the law was "a good first step in promoting a culture of safety."

He added that the next challenges for physicians are developing a quality-improvement infrastructure within their practices, maintaining the discipline needed to make full use of the law and getting doctors to be more open in discussing errors.

"Docs don't easily share information when adverse events ... occur -- but they do want to learn from them," said Dr. Straley, president of Group Health Permanente and medical director of Group Health Cooperative.

Dr. Straley suggested that practices start a file of reports of unusual occurrences that led to injuries or had the potential to cause an injury and review them regularly. He also said practices could look at other offices with quality improvement panels already in place and see what they did that had the biggest impact.

Dr. Straley noted that physicians probably would not be adequately reimbursed for their time and participation, but added that it was still the right thing to do and could pay off in the long run with better care and increased patient satisfaction. The committee can even fit into a practice's marketing plan. "Let patients know you have this system and you're concerned about patient safety," he said.

The law's sponsor, state Sen. Karen Keiser, said she was frustrated that not enough was being done to address medical errors.

"[The law] is a way to get at the medical community's fear that 'If I tell the truth, they'll sue me,' so now they can tell the truth," she said. "Liability has been everybody's excuse for not being straight with each other."