President's Page

President's Page
April 2005

First, Do No Harm—
Patient Safety and Quality Initiatives

by Leslie H. Secrest, MD
2005 DCMS President

Since the beginning of the practice of medicine, patient safety and quality improvement have been society’s expectation and trust delegated to medicine. The admonishment, “Do no harm,” is part of the fabric that makes a physician. Yet the process of taking care of another person often makes us realize that achieving such a goal is complex and difficult, no matter how well intended we are.

The Reports of the Institute of Medicine have confronted us—as physicians, members of the healthcare community, and members of the healthcare delivery system—with how frequently we miss our goal of safe, quality care. The reports reminded us that despite years of training and CME courses, we don’t know what we don’t know, and, occasionally, we don’t know how to apply what we do know. We often are amazed as to how the flaws in our safety nets, designed to keep us from doing harm, can become so aligned that a patient can fall untouched through safety nets that should have prevented their demise. Such events often become the headlines that grab our attention, frighten us, and engender the resolve that it could never happen here. Realizing that it happens wherever health care is provided has been a driving force to bringing quality improvement and patient safety initiatives to the forefront. Patient safety and quality improvement obviously are processes that have no end. However, at times, we may tend to make the process static rather than a dynamic requiring frequent changes of attitudes and behaviors that may seem counterintuitive to achieving our goals.

On Feb 1, the Dallas County Medical Society board of directors voted to establish a Patient Safety and Quality Task Force. The charge of the task force is to determine whether DCMS should have a role in patient safety and quality improvement initiatives. If we have a role, what should it be as it relates to advocacy for the membership in public policy, relationships with community resources, and relationships with elected officials, governmental agencies, and private business? Such a wide-sweeping charge could allow the task force to develop a committee and several subcommittees that can simplify and narrow our focus on a complex area of initiatives that are best suited for the Dallas County Medical Society and benefit each of us as members as we work to improve the health of our patients.

Quality improvement and patient safety will bring changes within all of us. It will move our attitude from the point of view that “It could never happen to me because….” to “I am human and that could happen to me— how can I improve?” If we change patient safety and quality to a continuous dynamic process, the process will make us better physicians with nonpunitive attitudes toward unintended outcomes that tell us we are humans with limitations, but we must change and produce different results.

The Electronic Medical Record is a concept that is fast approaching reality. Its development, implementation, and applications will fit nicely into the purview of patient safety and quality improvement. New adaptations and applications of electronic information will develop and new threats to safety will emerge. Clearly, quality will have an opportunity to improve by having all electronic medical information and data able to communicate with each other. Obviously, the ability to access a patient’s complete record at any time medical care is provided and to easily navigate through the record to find the desired information will improve patient care while decreasing costs from duplication of tests and efforts. However, cost savings must be returned to benefit the healthcare delivery system by directing the savings toward research and improvement of health care at all levels.

As electronic health information evolves, physicians need to take an active role in providing guidance and leadership. A Patient Safety and Quality Improvement Committee may be an appropriate place to begin positioning DCMS to be an active contributor in the creation of structures that will be required to make effective use of electronic health information and properly focus society’s expectations. I hope that by creating the Patient Safety and Quality Improvement Committee, we will address the issues we face as physicians and impact the delivery of health care for the future. We have the opportunity to put into action the vehicle that will become a standard, giving us a better understanding of what is necessary to improve as physicians, so we can better serve our patients and our profession.

If you are interested in serving on the Task Force or Committee, please contact Michael Darrouzet, DCMS CEO, at darrouzet@dallas-cms.org or 214-413-1422.

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