The costs associated with education and training have historically fallen upon the individual professional in pursuit of such effort. The costs associated with a medical, nursing or other professional license or certificate are staggering. However the professional recognizes that such pathways are an investment in themselves. Once complete the education and requisite skills are “owned” by the individual and afford them the opportunity to have a career in healthcare. Thus the bill is paid by the ultimate beneficiary of the education.
When a hospital employs or partners (in the case of non-employee medical staff) with professionals they carefully screen and ensure the educational history and licenses are in order. The hospital expects the professional to be competent in their field. This is a reasonable expectation as the hospital is engaging in a financial relationship with said individual. In common arrangements the costs of certification, recertification, and licensing fall to the responsibility of the individual professional to achieve. Again, you could argue this to be fair, as the healthcare professional “owns” that side of the equation, at least at the level of individual competence. Continuing education and professional development activities enhance the ability of the professional to remain competent as well as competitive in terms or one marketability as a healthcare provider. Largely these efforts are aimed at knowledge based activities that allow one to remain current in their field.
In recent years schools of health sciences have tried to embed some aspects of teamwork and communications into their curriculums. However, these effort thus far are still aimed at what ones individual competency or knowledge is on how to be part of a team. There still remains a huge unmet need to have practicing professional engage in multidisciplinary education efforts surrounding this important topic. Some of these efforts may naturally include simulation.
Hospitals offer healthcare as a service to patients in exchange for payment. Contained within is a “contract”, or at the very least a commitment, to provide excellent care. Inherent in the delivery of excellent care is error-free care that avoids preventable harm from being experienced by the patient as a result of the healthcare service(s) that they receive from a given hospital.
Additionally there is a “contract” between the hospital and the healthcare professional with which they are associated, to provide excellent care, and logically this includes error-free care. In exchange for the professionals providing this service enables the hospital to derive income. This income is shared with the professionals through two basic mechanisms. The salaries paid to employed professionals such as nurses, physicians, pharmacists for example. The second basic mechanism is the ability of non-employed physicians to derive income to their practice for the services provided under the auspices of the hospital. In this latter case, it can be oversimplified to a description of profit sharing for the purposes of this discussion.
While the knowledge and skills of competent individuals are attained during training programs we know that there are education and training efforts that is necessary for professionals to be proficient at the system level. In other words there is training needed for individuals to be competent to work within the hospital of which they are associated. This may include such training as procuring competence in equipment or policies specific to a hospital, training in systems efforts at patient safety, as well as team training just to name a few examples.
While most healthcare providers accept that their education and training to maintain individual competence is their personal responsibility, they will likely draw the line at footing the bill for those needed efforts that are specific to a particular hospital in their systems efforts. Such training efforts represent those areas that the hospital should be responsible for. They represent the training that is above individual competence and afford system competence to the professional. This allows a system of professionals to engage in the delivery of excellent healthcare and keep patients safe so that the hospital can generate revenue from such service provision. Thus it is necessary infrastructure, much like the electric or water bill for the hospital.
In the over-cited United States Institute of Medicine (IOM) report “To Err is Human” from 1999, simulation is mentioned 19 times. Team training and teamwork is frequently mentioned throughout as well. So then how is it that we still don’t have standardized and/or mandatory implementation of team training efforts, patient safety training, or simulation efforts?
The fundamental answer is that the hospitals have not been encouraged, cajoled, regulated or developed the foresight and understanding that training for patient safety is core infrastructure. It is incumbent upon the hospital to invest in this partnership with care professionals who do their part to maintain the competencies, requirements and licensure at the individual level. This will be the only pathway forward to achieve meaningful result from patient safety training efforts. This argument is also predicated on the notion that the reader recognizes that true patient safety training takes more than watching bad powerpoints once a year to satisfy regulatory and accreditation compliance.
So let’s cool the potato, overcome the obstacles and embed the costs of training for systems excellence into the infrastructure costs of hospital care and truly move the needle on patient safety.