Human and patient rights in prospect of the medical ethics and the quality and

safety of the health care system

Prof. Isuf Kalo Drejtor i Qendres Kombetare te Cilesise , Sigurise dhe Akreditimit te Institucioneve Shendetesore

isufkalo@qkcsaish.gov.al

Evolution of the people’s rights

18th century: Civil rights (freedom of speech, thought and religion)

19th century: Political rights (voting and election)

20th century: Social rights (education, health, pension)

Marshall, 1963

Patients and health care

1. Health care system

2. Health care delivery

3. Health care quality

Health system goals

Health gains

Responsiveness

Fairness in financing

Level Distribution

Quality Equity

Efficien

cy

}__________ ________

Evolution of health systems

Classical universalism:

All services for all

New universalism:

Only effective interventions for all (less is more…!)

WHO: World Health Report 2000

Oath of Hippocrates -400 B.C

Gratitude from the patients (famous painters )

to their health care providers • DADD: Portrait of Dr. William Orange ,

Portrait of Dr. Morison and Dr.Hood,1853

• Edvard Munch: “The Nurse” (Mss Schacke),

Portrait of Dr. Daniel Jacobson, 1908

• Frida Kahlo: Self portrait dedicated to Dr Eloesser

Self portrait with portrait of Dr Farill, 1951

Portrait of Dr Felix Rey

“In gratitude for the sympathetic treatment …”

V. Van Gogh , 1889

Biomedical Dimension

DOCTOR

Biomedicalknowledge

Signs & symptoms

biomedicaldiagnosis & treatment

diagnosis & treatment

Patient’s hidden thoughts

objective subjectivecomplaints complaints

doctor disease

PATIENT

Quality of health care: patients expectations

• Access to care• Equity , Empathy • Respect for their

preferences • Respect to their dignity,

privacy, confidentiality • Information and

accountability • Physical comfort • Emotional support • Involvement of family and

friends • Continuity

Health systems : What failures?

• Unsafe health system: non transparency on risks and errors

• Dissatisfied patients and healthcare providers

• Lack of accountability to the patients and public

• Inequity on access, practice and outcomes of care

• Corruption

• Ineffective/ obsolete health technologies

• Unjustified waste of resources

• Unaffordable cost to individuals and societies

• Slow progress towards standardization

Present distribution of the various types of intervention

_____________________________________________________________________________

• Za J.A. Muir Gray, Director of Research and Development, NHS Executive, Anglia and Oxford Region.

• „Evidence-Based Healthcare”

Of unknown effect

Do more good than harm

Do more harm than good

Unintentional incidents registered in 2002

Dept. of Int. Care: 223 anonymous registration formsHaukeland University Hospital: 343 “official” errors

Other errors24% (55)

Medical errors21% (47)

Infusion errors10% (23)

Procedures45% (101)

Titles of some BMJ articles -2002

• “Why the Hippocrates ideals are dead ?”

• “Deprofessionalising doctors ?”

• “Why so unhappy?”

• “Dishonest doctors should not continue to practise .”

• “Helping doctors to help themself .

We all must think to find new ways to correct the problems that

we have created with our previous ways of working.

Albert Einstein

Restatement of the Oath of Hippocrates , 1995 –(fragment)

…With PURITY, HOLINESS AND BENEFICENCE I will pass my life and practice my art . …I will neither treat any patient nor carry out any research on the human being without the valid informed consent of the subject …I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from seduction of any patient….

“To write prescription is easy , but to an understanding of people is hard “

Franz Kafka in “Country doctor “

People and health system

• Citizens/Community• Patients/Families• Health Care Providers• Health Administrators• Third Party Payers• Policy Makers

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The multiple roles of peoplein health systems

Patients and populations

Contributors

Providers

Co

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um

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Cit

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Financing

Hea

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Ste

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Production of goods and services

World Health Report 2000 -

Health Systems: Improving Performance

Partnership in health care is crucial

The equilibrium between doctor and patient

signs & symptoms THERAPY

empowerment

loss of power

mourning - coping

health beliefs

locus of control

diagnosis

suffering

therapeutic education

doctordoctor patientpatient

selection of ttt

Follow up of ttt

Each person has to deal simultaneously with both factors

RECOMMENDATIONSNATIONAL MEDICAL ASSOCIATIONS

QUALITY OF CARE DEVELOPMENT -1994

“National Medical Associations should promote Quality of care as professional

ethical obligation and institute the internal self-evaluative mechanisms among their

members”.

Directions for improvement of the quality in health care provision

• Professional: the way care is delivered- overuse, under-use, misuse.

• Organization: the way care is organized- access, waiting time, communication gap, coordination.

• Relationship: the way care is provided- co-decision-making, empathy, information.

doctor

Doctor Patient

Biomedicalknowledge

Signs & symptoms

Socio-cultural group

Psychosocial & Educationalskills

Biomedical pole

Psycho-educational pole

biomedical, psycho- educationaldiagnosis & treatment

objective subjectivecomplaints complaints

The doctor helps the patient to express his/her:- preconceived ideas: diagn & ttt- health beliefs - experience,- expectation, - fears, coping

diseaseperson

Bio-psycho-social and educational dimensions

Therapeutic Patient Educationin the field of prevention of NCDs

Definition of Therapeutic Patient Education

1. Therapeutic patient education should enable patients to gain and maintain abilities that allow them an optimal management of life with their disease.

2. Therapeutic patient education is therefore a continuous process which has to be systematically integrated in health care.

3. It includes awareness, information, self-care learning and psychosocial support regarding the disease and the prescribed treatment.

4. Its aim is also to help patients and their families to better cooperate with healthcare providers and maintain or improve their quality of life.

empowerment

treatment

psychologyeducationbiomedicine management

health beliefs

evaluationof follow up

management of phone calls

structuredinteractive

visits

detection of complications

diagnosis therapeuticeducation

relapse prevention

therapeutic homework

coping with the illness

locus of control

Long term follow up of patients

Self portrait with Dr Arrieta

• “In gratitude to my friend Arrieta : for the compassion and care with which he saved my life , during acute and dangerrous illness …”

Francisco Goya 1820

Building bridges: professions and the public

• Self regulation

• External assessment

• Patient involvement

• Professional accountability to public

• Public reporting of health care data

Fiona Moss, 2001

“In God we trust”

Everyone else must provide evidence!

Accountability

includes:

• Answerability : the right to receive relevant information and explanation for actions.

• Enforceability: the right to impose sanctions if the information or rationale is deemed inappropriate

The Albanian health system:Under pressure to change

• From the inside - new socio-economic situation - democratization (people’s civil and political rights) - free initiative/market, privatization, competition

• From the outside - regional and European integration - international commitments and standards - globalization (“death of borders” )

National Centre of Quality, Safety and

Accreditation of Health Institutions

Patients sector :• Rights and roles • Information • Therapeutic

education • Organization and

empowerment • Safety

The culture of quality in health care means a state where everyone is:

- aware of the quality concept- believes in it- practises its principles- makes it part of his/her responsibility

All our dreams can come true

if we have courage to pursue them

Walt Disney