Patient Safety and Ethical Practice

The Patient Safety portfolio includes educating medical students and health professionals about the context of health care and the role of complexity. Understanding how poorly designed systems can lead to inadequate care and the role the system plays in minimising error is necessary if health care professionals are to reduce adverse events suffered by patients.

Medicine is practiced in a complex environment, so there are usually many factors contributing to poor outcomes for patients. Most of these errors are not caused by people acting recklessly but by badly designed systems of health care. We know that people are reluctant to talk about adverse events, but if there is no acknowledgement of them, it is impossible for improvements to be made and learning to occur.

Professional and ethical behaviour
Professionalism and ethical conduct are important components in patient safety. In the health care setting, the term professionalism covers those attitudes and behaviors that serve to promote and maintain the patient’s best interests. Ethical behaviour is a mandatory component required by all health professions and employers and covers a range of attitudes and behaviors. All our patient safety work includes teaching students and health care professionals about their professional obligations and responsibilities to patients, their colleagues and the wider community.

Associate Professor Merrilyn Walton is Chair of the Personal and Professional Development Theme in the University of Sydney Medical Program, and the Director of Patient Safety in the OPME.
Her particular interests include changing the work environment for junior doctors, educating health care workers about patient safety and advocating for patients to be fully engaged in health care at every level.

Current projects and teaching

Visiting Professor and Affiliate of the Buehler Centre for Aging, for the Patient Safety Education project, Northwestern University, Chicago.
The United States Patient Safety Education Project is built on the National Patient Safety Education Framework, which guides its scope and content. It is designed to be a train-the-trainer education-dissemination program that seeks to raise the level of patient safety education and practice for people already in practice. The PSEP program will teach teams of physicians, nurses and administrators to become Trainers who will then go back to their institutions and teach patient safety using the Core Safety Curriculum, which is designed to be adaptable to diverse groups and to different levels of expertise in patient safety. A roll-out of this program in Australia is being negotiated for 2009.

A Workforce Study of Prevocational Doctors in NSW
This project is being carried out by a consortium led by the University of Sydney (including the Northern Rivers University Department of Rural Health) in collaboration with the University of New South Wales and the NSW Rural Doctors Network. A/Prof Merrilyn Walton is leading this project which aims to examine the educational, training and work experience of all pre vocational (non specialist) doctors in the New South Wales health system, including a sub set of International Medical Graduates (IMGs) working in NSW hospitals. This project is funded by a grant from NSW Health. The data for this project has been collected and is currently being prepared for analysis.

Trial of new assessment methods in the Personal and Professional Development Theme of the University of Sydney Medical Program
The research team consists of Merrilyn Walton (Assoc/Prof, OPME), Narelle Shadbolt (Sub Dean-Hornsby Hospital & Lecturer - Discipline of General Practice) and Louise Cole (Sub Dean of Education, Nepean Clinical School).
Workshops were conducted at a number of clinical sites in 2007, introducing the techniques and theory behind the new assessment tools. The formative OSCE for Med 1 was in September 2007 and Med 2 was in April/May 2007, the summative at the end of Year 2 was in November 2007. These assessments are on-going.

Encouraging and Managing Student Professionalism in the USydMP
A new policy and reporting tool to manage student professionalism was piloted and evaluated in 2007. The evaluation was managed by Associate Professor Merrilyn Walton, who continues to monitor it.

PPD Curriculum Development
As a result of the review of the Sydney medical program Merrilyn is developing the Personal and Professional Development Theme curriculum around Patient Safety, Clinical Ethics, Health Law and Professionalism for all stages of the medical program.

World Health Organization (WHO): The Development of a Medical School Patient Safety Curriculum
A Patient Safety Curriculum Guide for use by all medical schools, irrespective of geography, is being designed by a team of medical educators led by Merrilyn Walton and including Tim Shaw, Chris Roberts, Stewart Barnett and Samantha Van Staalduinen from OPME and Brendan Flanagan and Julia Harrison from Monash University. The WHO has funded this work. The project will undergo five stages of development: the Educational Template; a Literature and Resources review; the Curriculum Guide (what to teach and how to teach patient safety); a review of the Curricular Guide by an International Reference Group comprised of medical schools in Vietnam, Chicago in the United States, South Africa, Japan and the United Kingdom; and the final Curriculum Guide.

Professional Development program for vocational trainees
Developed and delivered to the Sydney South-West Area Health service. Merrilyn continues to develop this program within the Institute for Medical Education and Training.

Completed projects and teaching in Patient Safety since 2000

• Teaching in the Clinical Practice Improvement Program, organised by NICHI, 2000 - 2007
• The Psychological Impact of Complaints and Negligence Suits on Doctors. A collaborative research project between UNITED Medical Protection (UMP) and the University of Sydney, 2003 - 2007
• National Patient Safety Education Framework 2006
  http://www.patientsafety.org.au
• Short course in patient safety for Registrars and nurses in Victoria’s hospitals. A pilot developed with CIPHE in 2005-6.
• Ministry of Health Japan A/Prof Walton was a co-investigator on research into patient safety education, 2005.
• The delivery of a three-day seminar on patient safety for 140 doctors in the National Guard Health Affairs in Saudi Arabia, 2005.
• China Health Care Safety Roundtable, China Ministry of Health, 2005 A/Prof Merrilyn Walton was a key-note speaker.
• A/Prof Walton has been involved in a Vietnamese collaboration since 2001. It has included developing and conducting short course on Teamwork and Communication with patients and relatives for Bach Mai Hospital; assisting Hanoi Medical University to develop a Medical Ethics curriculum; presenting educational safety and ethics seminars to Vietnamese academics in Hanoi and teaching medical teachers how to teach medical ethics; presenting seminars on medical errors and safety at Viet Duc Surgical Hospital and Bach Mai Hospital, Hanoi; preparing a Medical Ethics reader for translation into Vietnamese.
• Open Disclosure project, funded by the Australian Council on Safety and Quality in Health Care, 2003.
• Academic Review of Australian Patient Safety Survey – final report to the Commonwealth Department of Health and Aged Care, 2001.
• Consortium member for Improving Blood Transfusion Using Breakthrough Methodology, 2001 – 2003, funded by the Institute for Clinical Excellence.