4033.0: Tuesday, November 14, 2000 - 9:30 AM

Abstract #10519

Bioethical perspectives on developing a typology of risk, error and resolution in health care

Joanna K. Weinberg, JD, LLM, Institute for Health & Aging/ Dept. of Social & Behavioral Sciences, UC San Francisco, Box 0646 Laurel Heights, 3333 California St, San Francisco, CA 94118, 415-502-5204, weinbgj@itsa.ucsf.edu

This is a conceptual analysis of how the nature of error or mistake in health care should be assessed, measured or controlled. Using a bioethics framework, we suggest that the concept of error should extend to breakdowns in system structure, organization and communication, and that the participants’ (patient and family) perspectives about a particular encounter or incident should be integral to a definition. The paper poses the following questions: * What is the definition of error: what are the parameters of error classification, what is the patient/ consumer ‘s role in determinations of error or mistake? * How does managed care affect the definition of error or mistake, especially with respect to systemic problems in administrative oversight or procedure? * Are existing mechanisms for redressing error overly expansive or inappropriately narrow, and should there be a remedy regardless of whether there has been harm? * What criteria should be used to determine whether to apply punitive sanctions, restorative actions, or systemic restructuring? Through policy analysis and key informant interviews, we developed a typology of participant perspectives (patient/family, health institution; and regulators); of process objectives (i.e. conflict resolution or fact finding); and of resolution models: general oversight; individual case review (plan-based, legislatively mandated or external); and accrediting mechanisms. For many individuals, preservation of a relationship may be critical to maintaining physical and psycho-social well-being; but as the rapidly changing structure of the health care system has created new layers of administration and oversight, the relationship may become difficult to preserve when conflicts or perceived conflicts occur.

Learning Objectives: At the conclusion of the session, the participant (learner) in this session will be able to: 1.Decsribe a typology for defining and understanding medical error 2.Articulate the proceedure for assessing the effectiveness of a particular resolution model 3.Utilize the case studies provided as examples of the typology in operation

Keywords: Bioethics, Communication

Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

The 128th Annual Meeting of APHA