Connecting Moral Agency and Patient Safety in HCE Research Paper

Abstract

There is a general increment in the Safety of patients as a theme in delivering healthcare services in recent days. This of course is not surprising based on the fact that the healthcare sector; pharmacy, nursing, and medicine has had a close watch on ethics in the fore of practice as a new dimension to bringing about better delivery to the patient. Also, only recently, there is an increase in the awareness of the consequences of failure to be practical in the adaptation of ethical imperatives. There is a general awareness of the technique which is employable in bringing about realism to the noxious ideal of not preventing harm in healthcare practices. The realization of the weight of failure to acknowledge the possibility of bringing about reduced harm in healthcare delivery has fortunately brought about intensification in researching flourishingly on the safety of patients as well as the desire of investing into researches on the safety of patients. For instance, a publication on the subject matter by the Agency-For-Health-Research-And-Quality (AHRQ) received tremendous assistance from America’s department-of-defense as well as several other publications that have been evident of the resulting blossom of research on the subject in discussion. This paper deliberates on the subject matter of justifying the shift of focus from blaming individuals for medical errors to developing systems for patient safety in a holistic and investigative approach.

The Problem of Medical Error in Healthcare

The safety of patients is becoming a more pronounced theme in delivering healthcare services in recent days. This of course is not surprising based on the fact that the healthcare sector; pharmacy, nursing, and medicine has had a close watch on ethics in the fore of practice as a new dimension to bringing about better delivery to the patient. Also, only recently, there is an increase in the awareness of consequences of failure to be practical in the adaptation of ethical imperatives. There is a general awareness of the technique which is employable in bringing about realism to the noxious ideal of not preventing harm in healthcare practices. Patients are usually required to complete a form to provide information this is relevant for actualizing their safety.

Realizing the weight of failure to acknowledge the possibility of bringing about a reduced harm in medicine has fortunately brought about intensification into researching flourishingly on the safety of patients as well as the desire of investing into researches on the safety of patients. For instance, a publication on the subject matter by the Agency-For-Health-Research-And-Quality (AHRQ) which received a tremendous assistance from America’s department-of-defense as well as a number of other publications have been evident of the resulting blossom of research on the subject in discuss.

No doubt, the advent of emphases on patients’ safety in the healthcare sector is appropriate and very timely. A decade or two ago, the application of systems-thinking to the safety of patients was ‘unenlightened’ and would not be welcome. Perhaps up to this day, preventable-patient-harm is again and again linked with error– which is fundamentally human-natured– particularly at the level of utilization of ‘liable medical systems’. To a lot of minds, the occurrence of this kind of error has to be met with blames and punishments. However, presently, system thinking is ubiquitously acceptable in the healthcare sector largely based on its success to introduce a continuous-process-of-improvement which has brought about a reduction in the threat to continual practices in the healthcare as compared to earlier reliance on accusations-of-error. It has been emphasized:

…to refuse to take part in committing an injustice is not only a moral duty, it is also a basic human right. Were this not so, the human person would be forced to perform an action intrinsically incompatible with human dignity, and in this way human freedom itself, the authentic meaning and purpose of which are found in its orientation to the true and the good, would be radically compromised.

In any case, system thinking is not naturally occurring- particularly as could be seen in the healthcare profession. The healthcare practitioners is adequately trained and is acculturated to realize the selfless responsibility and to have a mastery of the knowledge/skills required for assisting sickly ones or patients – who are for the majority of the times dependent and vulnerable. Of course in the knowledge of this, one is convinced that Hippocrates and Florence-Nightingale in their dictum have no harmful effects on healthcare practitioners in individual ways- neither does it have any harmful effects to the system whereby they find themselves working in.

There is an emergent dimension to healthcare systems safety which has brought about a number of challenges as follow:

1. “It has been said that a system is perfectly designed to produce the output that it produces; or conversely, whatever output is gotten from a system is what the system is designed to produce—whether the design of the system was planned or unplanned, and whether the results were intended or unintended;
2. “Systems are composed of multiple, interconnected components: people, machines, processes, and data. Each component may directly or indirectly affect not only the function of the system as a whole, but also the functions of other components;
3. “The goal of a system is to maximize the output of the system, not the output of each of its components. Every system, including those in health care, must be optimized—rather than maximized—the performance of each of its components in order to maximize the system’s output;
4. “The output of a system has multiple dimensions. In health care, the dimensions of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity are often used to describe the output of the system. But it is uncommon for any system to maximize the level of every one of the multiple dimensions of its output; rather, the system must optimize the level of each dimension. This optimization is a value judgment by those who design the system, who manage the system, and who use the output of the system. And these three parties, the stakeholders in the system, do not always agree on the relative priorities for the dimensions of the system’s output;
5. “Most systems are open systems; that is, they are affected by—even dependent upon—larger systems of which they are a part and, in turn, they provide inputs to the larger systems. In health care, we have learned the value of studying and changing microsystems; the people, machines, and data at the level of direct patient care (the treatment team within the hospital or the physician office practice, for example). But these microsystems are subsystems within macrosystems; the organizations such as hospitals, nursing homes, and clinics of which the microsystems are components. Of course, these macrosystems are part of the megasystem of the United State’s healthcare, which is a component of the even larger economic and social metasystems of American society as a whole; and
6. “Complex systems (and even the microsystems of healthcare are complex) and open systems are both at risk of producing unintended consequences. Even apparently ‘inconsequential’ changes in healthcare microsystems and macrosystems will almost always produce unintended consequences. While it is predictable that unintended consequences will emerge, what those consequences will be—and whether they will be beneficial or deleterious—is often unpredictable”.

Consequently, where as systems-thinking brings about fresh and better goal-oriented approaches to the realization of improved patient safety, it is also responsible for bringing into play a number of confronting conceptual challenges- and most of the times, when there is the failure to identify and address these confrontations, there is usually a slowdown to the progressive and newly introduced harm.

The challenges demand for a personified intensification on the learning of the workability of systems thinking to healthcare through addressing certain questions as follow:

“What are the microsystems and macrosystems in health care? How can their performance be measured? How do they interact? What are their vulnerabilities—and strengths? What are the strengths and weaknesses of each component that comprises the system? How can those strengths and weaknesses compensate for each other within the larger system?”

Several of the questions have also been addressed directly or indirectly and focally in a number of publications on the topic in discus. The provision of answers to these raised questions is helpful in framing an intervention as well as interpreting tools which is relevant in addressing the issue in question. Answering the system-questions is equally reminding about the complexities that could be found hidden in other studies’ out come. The major difficulties of these ‘system’ are actually an intellectual copy of human kind and the way its function. Notwithstanding the closeness to rounding up our model possibly may be inconclusive and inappropriate. Again, the usefulness of our model will never give an appropriate solution to every inquiry been framed. This is more of the reason why evaluating a system components and outputs could be in various approaches; even if its goes in opposite direction and in the process of analyzing the outcome in different way could give us a different conclusions based on how the system functions or produce an entirely fresh design. Utilizing a system’s approach to drastically minimize damage that may surface in health related issue has given room to different human innovations and includes physicians, nurses and even pharmacists who are all in the system. An article drawn from debates of Dissemination-groups of AHRQ Patient-Safety-Research-Coordinating-Center-Steering-Committee gives incisive system analyses base on steps in transforming research into practical term.

The array of Medical Error

Improvements of well-precise and cautiously constructed performance procedures is crucial in the process of carrying out provider’s real performance and evaluate performance with the real aim of getting standard. With the widespread experience of HCE who are ready to engage the provider to increase performance procedure that will efficiently appraise the accurate level to which the proper and projected course of outcome is being followed and the level to which the projected results are being realize.

Understanding Patient Safety Events

HCE proffer widespread know-how in providing medical documentation appraisal services which looks out to see that the service being rendered to patients is perfects, essential and up to standard base on lay down rule. For over thirty years now, the HCE has been carrying out standard medical documentation appraisals in various levels which include acute-inpatient and outpatient-facilities, ambulatory-surgery-centers, knowledge-base-nursing-facilities, home and health agencies, medical-expert’s offices, and supervised-care-reviews. A unique understanding put together to assists the safety of patience can be seen in the area of fee-for-service and manage-care-reviews. Whether one is looking out for resource experts to train own staff in the area of case review or needs the assistance of experts to help finish any review or abstraction, these are the experts whom can be call upon.

Naming Blaming / Shaming

The capability to arrive at a decision base on an informed knowledge in health care delivery is often hindered by lack of proper information on the results of the presence practices. HCE looks out to assists performances advancement efforts of the health-care-providers in each area they serve. They are committed to the realizing of successful, resourceful and economical delivery of excellence health-care-services, with the help of resource expert and their accuracy in different data collection, collation and reporting. The so called health-care diagnostics involve excellence procedure, creating metrics and baseline plan design, and evaluating health-care style. For engaging in this HCE gives our patients the following:

• Carrying out a kinds of statistical breakdown of Medicare data (for administrative and chart based),openly announce data on Home health, Nursing-Home and Hospital-Compare C-M-S Site; MDS and OASIS data; hospital and outpatient requests; and plan data, creates great level of summaries and summative rate;
• Stand as an unbiased party to join, scrutinize, and current collective data from various sources or bodies (e.g. health-plans, difference providers) that are unable to share secret data with each other in the business;
• Produce a report with a modify outcome for people and respondents(e.g. personalized reports for each nursing home and hospital);
• Table and puts data in collection for task which involve evaluating of data collection procedure (standard) developing materials;
• Statistical or data professionals involve:
  • Widespread breakdown making use of SAS (e.g. Frequencies,-means,-variance,-regression,-significance tests) Learn design and breakdown of methodology: Style, program-monitoring, and run and control-chart;
  • SAS System for regular analysis;
  • Big and small kind of database;
  • Data collected in difference format Data received in various formats, and
  • Clearing and authentication of data.

Realization of better outcome requires making formatted-Excel-spreadsheets or Access-databases for information input, output report which involve charts,-graph,-map, and other way which can show result and template couples with chart to be use for output information for monitoring to bring about:

• Recommendations that have been considered necessary for improving cost-containment could be very vital in identifying incidences that are necessary for generating positive changes;
• Experiences that are associated with health-data-claims are vital for a better understanding of the potentials and for a better comprehension the short comings of healthcare data- in the same way, the numerous approaches that have been put in place is considered to be a solution to policy issues;
• Identify the extreme costs that accrued patients who have nearly the same characteristics is considered to be helpful in sorting out the ‘cluster’ or the sub-groupings of intensive-resourced patience who can be classified nearly equal interventional characteristics for the improvement of control-costs as well as for an improvement of care-coordination; and
• A determination of the studies in achieving high quality and containment-cost in specified disease conditions as well as medication-use issues.

Medical Error as a Problem in Organizational Ethics

Emergent incidences of risk are not just found with patients, there is also the instance that same is noted to be of high signifcance to the organization invlved in patient’s safety. It has been noted from studies that:

it’s not just the individual human tragedy of fatal incidents, but also the damaging costs of litigation and insurance claims. There is therefore the need to create a dedicated section to collect the latest trends, news and information about the issue of patient safety in the world (JEJ3003).

Ethics and Professional Behavior

At HCE, there is the understanding that effective performance measurement provides information about how well processes are working to deliver patient care in a given organization.

The HCE work has been adequately equipped with skills and knowledge to exhibit professionalism is the actualization of realistic performing measures as well as evidence-base health care delivery through a resounding approach by which data is studied carefully and identified for realizing an improved patient-safety strategy.

Analyzing the quality of healthcare in specialists is very vital in the identification of the potentials which demonstrate a positivity of change. Additionally, the platform presents the avenue for educating and utilizing views as well as a number of services which could be made use of in converting raw information to actions. The HCE presents a systematic collection of raw information and analytical services which support quality of health care as well as improve the safety of patients to include the following:

• Advising providers and consumers on collection and use of valid and reliable data for quality assurance and improvement;
• Assisting provider organizations in submitting data for public reporting; and
• Maintaining extensive and detailed lists of providers through HCE’s contact Management system, which may be used for surveys, mailings, maps, and other analysis?

The HCE has equate and comprehensive knowledge of the raw information as well as the confidential requirements about HIPAA’s compliance. Securing raw information is very essential for the HCE in order to bring about the stability of a procedural, electronically, and physical safeguarding of connections which constitute receipts as well as electronic-data storage.

The HCE has enormous confidence as well as a disclosed policy which could be applied to the social-security –act and, the code-of federal-regulations, as well as to the Medicare-quality-improvement-organization’s manual citation.

Physician’s Value and Patient Autonomy

Physician’s values encompass and demonstrate the recognition that several integral health-care aspects are reliant on units that may include life-value and quality judgment that are integrally a subject of analytical methods. It is the fore concern of Physician’s Value and Patient Autonomy to make clear aspects of practices of medicine which are principally subjected to methods that are scientific and applicable for ensuring the most accepted predictions of clinical treatment results; although debates linger on the authenticity of the desirability of these outcomes. It is the advocacy of Physician’s Value and Patient Autonomy to ensure thrives of recent clinical decision-making which must be reliant on the usage of ‘best’ up-to-date scientific evidences. For this school of thought, Physician’s Value and Patient Autonomy offers the following three (3) key merits:

1. It gives the most accepted and objective alternatives in the determination and maintenance of consistent and committed qualitative standards which are safer for utilization in practice of medicine;
2. It aids in achieving speed in processes of converting medical researches and findings into medical practices; and
3. It avails the potency for the reduction of costs in Medicare or health-care, considerably.

This school of thought which supports Physician’s Value and Patient Autonomy is not without opposition as it is otherwise considered that Physician’s Value and Patient Autonomy risks downplay of the vitality of medical experiences and expert opinions. It is also argued that the terms used by clinical trails in the definition of ‘best’ practices are complicated and not routinely replicable and are not practical. Subsequently, there are emergent movements such as the Cochrane Collaboration- which was instrumented to retort Archie Cochrane’s call for the development of instantaneous systematic evaluations of randomly regulated trails which encompass all sectors in health care utilizing most excellent available evidences in healthcare decision-making processes.

A persistent challenge that has continued to be associated with Physician’s Value and Patient Autonomy translation of knowledge and how to ensure an effective day-to-day clinician decision making regarding appropriate values on existing ‘best evidences’. Once too occurring, clinicians are ignorant of existing evidences or neglect the applications. Otherwise, values of clinicians vary considerably from patients, hence even when clinicians are sentient of the evidences there is the tendency that their suggestions would be fellable without an involvement of patients in the processes of making decisions.

Legal, Ethical and Professional Problems of Medical error

Errors in the health care sector could be grouped as those that are based on skills, those that are based on rule, those that are reliant on knowledge as well as a number of other such as those which are inclined to judgment there is a very clear line when non negligent and negligent errors are ex-rayed in law. It has been stressed that:

The description of a mistake as an error of clinical judgment is legally ambiguous, since an error that a physician might have made when acting with ordinary care and the professional skill the physician claims, is not deemed negligent in law.

It is further noted that:

If errors prejudice patients’ recovery from treatment and/or future care, in physical or psychological ways, it is legally and ethically required that they be informed of them in appropriate time.

It is absolutely necessary for high ranking medical practitioners to be appropriately cautious of the gravity of the various error forms in order to adopt preventive-education or any other machinery that could be structured for the benefit of the patient. This is necessary to take into account because an error that a clinician may legally be liable for could actually have a systematic origin which could defect an institution’s administration.

Factors Affecting the Performance of Health Care Professionals

The following factors are listed:

• Team Work and Communication Error, practicing in the healthcare unprofessionally in the health care is certainly unethical, defrauding, and harmful to the public. Considering an event whereby an individual affords to posses falsified practicing licenses or documents, for instance, the act speaks volumes of misconduct against health care practices. There have been reported incidences of state-boards-of-nursing initiating disciplinary actions on nurses for correcting events of on-field conducted errors, which could include medication-errors as well as negligence and malpractices which are provided by health care service providers. emergent questions regarding incidences whereby there is injuring or harming of patients by a nurse through medication-error or through a sort of negligence could include the determination of whether to hold the health care service provide liable to the act as criminal or to ignore same. Thirdly, there is the concern for to monitor unprofessionalism and on ethical practices in the field. this may have to do with violating or bleaching a patient’s confidence through a non-acceptable sexual conduct with a patient (whereby the patient is harassed or staff-members are harassed). This is also the concern for racial discriminations of patients on the bases of there religion, ethnicity, or similar characteristics. A number of heath-care boards do emphasize the need for staff to adhere to ethical codes-for example, the American-Nurses-Association’s code-of-ethics adopted by nurses for monitoring ethics has been incorporated in the NPA’s ethical codes.
• Accountability and Responsibility, The realization of safety of the patience could equally incorporate adopting to principle that uphold responsibility and accountability aand which are against criminal-convictions, convicting the healthcare provider for felony or for moral turpitude and gross-immorality. It is reviewed that:

Felonies include fraud, misrepresentation, embezzlement, patient abuse, and murder. In some states if the nurse is convicted of a felony, he or she is barred from practicing for a certain period, which can be up to five years or more.

Alcohol has been singled out as a distinct reason for disciplinary-actions as well as abusing substances. Several state-boards of nursing have realized that addition is a kind of illness that demands for treatment. Where as such boards have to retain the protection of the public through removal of impaired nurse licenses, there is an equal need for opening up treatment opportunities, as well as rehabilitations and entry-back into working environments. To ensure discipline in the nursing field for instance at the HCE for instance, it was noted:

“At one time, nursing licenses were simply taken away and impaired nurses had to endure very harsh treatment”.

Presently, a number of states have put in shape structures which permit impairing of healthcare providers for shielding against disciplinary actions incase the nurses get into any form of approved-treatment facilities or programs- this has proved very successful in meeting up with effort to ensure patients’ safety rather than blaming.

• Clinical Boundaries and Culture of Individual Blame, It is worth knowing that Clinical Boundaries and Culture of Individual Blame evidences do not produce clinical decisions by themselves except they provide ample support for processes of patient care. The complete integration of the various mechanisms of Clinical Boundaries and Culture of Individual Blame into decisions which are clinically based on augmentative opportunities is for producing best clinical outcomes as well as bettering life’s quality. The conduct of Clinical Boundaries and Culture of Individual Blame is fostered by patients’ encounter which produces questions concerning how effective the therapies may be on diagnosed disorder.
• Organizational Moral Agency, IN presents practices in the health care, the has been the issue of increased-workloads, reduced-funding, and higher-patient-acuity such that nurses, for example are certain to conduct their functions based on comments from colleagues on the unprepared-nature newly qualified-nurses in practicing. The organizational moral agency is a structure to institute an appropriate conduct on healthcare services provider for the realization of safety of patients. Without an appropriate organizational moral framework, clinicians are ignorant of existing evidences that enhance their safety. Otherwise, values of clinicians vary considerably from patients, hence even when clinicians are sentient of the evidences there is the tendency that their suggestions would be fellable without an involvement of patients in the processes of making decisions.

The Ethical Obligation to Improve Patient Safety

Root Cause Analysis

• Joint Commission Accreditation Policy

This entails a unified monitoring policy on enhancing patient safety through effective implementation by health care regulatory agencies. An example is the instance where a number of heath-care boards do emphasize the need for staff to adhere to ethical codes-for example, the American-Nurses-Association’s code-of-ethics adopted by nurses for monitoring ethics has been incorporated in the NPA’s ethical codes.

Developing Organizational Systems for Patient Safety

Development of organizational structural systems for patient safety has been structured to oofer the healthcare worker with required guardians for addressing therapy incidences in caring for patients with health disorders. In the United States, this has been actualized through behavioral-health-standards and competencies-initiative which is put together through a national-consensus-building-project which unified an approximately two hundred patients and healthcare practitioners.

• Reporting Systems/Disclosing Errors

Reporting systems are necessary for an articulation of recurrent errors that are encountered in dealing with patients. In the HCE, reporting systems/disclosing errors is realized through comprehensive knowledge of the raw information as well as the confidential requirements about HIPAA’s compliance. Securing raw information is very essential for the HCE in order to bring about the stability of a procedural, electronically, and physical safeguarding of connections which constitute receipts as well as electronic-data storage.

The HCE has enormous confidence as well as a disclosed policy which could be applied to the social-security –act and, the code-of federal-regulations, as well as to the Medicare-quality-improvement-organization’s manual citation.

• Creating a Culture of Safety

Creating a Culture of Safety targets to achieve the application of the finest evidences acquired from scientific methods for the benefit of taking medical decisions. It makes efforts to evaluate the potency of evidences accrued to risk and the benefit of treatment (which includes treatment deficiencies) and test diagnostics. Otherwise, Creating a Culture of Safety can be said to be an integration of the most excellent evidences acquired through researches that are for the benefit of values of patients as well as for clinical expertise. These evidences span in application in areas of Medical Trials, Placebo-Control, Double-Blinding, Systematic-Reviews and in Meta Analyses. This paper will discuss studies and mathematical applications of Creating a Culture of Safety in the areas of Diagnosis and Screening, Disease Treatment, and related Medicare and therapy in a bid to accept or disprove the argument of whether Creating a Culture of Safety is real-life achievable and practically relevant or whether it is symbolic and still requires extra modeling and theoretical advancement for the benefit of diagnostic medicine.

• Preventing Harm and Improving the Practice Quality

Preventing harm and improving the practice quality is a necessary assessment tool for ensuring patient’s safety without necessary laying blame s on them; through this device, questions are asked for the singular purpose of improving the safety of patients which could be apprised and applied to the patient through an integration of evidences and clinical expertise. And then, there is the evaluation of the performance with the particular patient. It is mathematically functional to analyze a composite fundamental result of augmented compliance in line with medication through typical numerical approaches. One such approach is addressed through three questions which are fundamental to determining the compliance with emergent evidences. First, the authenticity of a diagnostic test and the certainty of evidences must be questioned. Secondly, the specificity of the evidences regarding patient disorder is considered, and then follows the specific-patient applicability of the valid diagnostic test. There is however the complexity of misinterpreting such diagnosis and screening at early stage disorder since the disorder may be without symptoms in an individual.

It is likely to ignore the relevance of applicability of mathematics to preventing harm improving the practice quality -however, a number of specialist cardiac surgeons have considered that there is an inextricable tie between the both because, in there view, mathematics has played significant roles in surgical operations and in the entirety of general practice of medicine-particularly, as has been supported by Creating a Culture of Safety.

Application of mathematics, especially probability, has had its way, through pathological and physiological processes, in the validation of medical hypotheses; whereby the knowledge is not just put to use for testing fresh ideas but also in non-invasion for monitoring conditions of patients and then prognostication.

Mathematics is highly used in analyzing data for the determination of two-way traffic receiver-operator transmissions; this is especially found applicable in the determination of prognostic power of an outcome whereby the odd-ratios of an occurrence permits for more utilization of obtained results. Models produced from mathematics, apart from supporting in the organization of concepts and in analysis of data, are very effective tools for simplifying systems that are biological in nature and hence allow the earlier feasible examination of thoughts that eventually could be examined through the use of controlled randomized trials. Further more, the models permit for taking a test of acute instances which could not be vulnerable to clinical-trial examinations. The models are specifically of value in analyzing processes that are pathological and are made use of in syndromes that have an effect on the functioning of several units such as metabolic syndrome. Several normal- function-and-disease-state models has been produced from the utilization of mathematics and are effective in analyzing cellular situations such as Transmembrane Ion Fluxes, in checking body systems; such as Obstructive Sleep Apnea, as well as analyzing epidemical outbreaks such as influenzas.

With the identification of present data which can be used for answering clinical questions, there are existent fundamental questions which demand answering with regard to specific studies. These questions include confirmation of the validity of the studies, the specificity of the results obtained, and the helpfulness of the result with regard to the indentified case of the patient.

The subject or concern for validity expresses how ‘true’ the information obtained is- this information is mathematically considered or regarded as data because is fundamental for instrumentation of appropriate treatment of the patient.

Presently, studies are concerned about resulting issues of preconception, which may occur from consciousness or from unconscious interactions. Study-methodologies regarding Creating a Culture of Safety such as Blinding and Randomization are of high emphasis in insuring that values resulting from related-studies are protected overly by the individuals who are studying the medical situations of the patients or by patients under study.

Evaluation of acquired medical literature poses many challenges and involves mathematical methodologies. One may note that results derived from the questions concerning how valid the data is may sometimes lack clarity as may be stated in the source they are obtained. It may then be very necessary for the clinician to decide on their own what to do concerning the value of the questions.

Once there is the determination concerning the validity of the methodology of the studies, it is appropriate to consider carefully the derived results and then consider how applicable the obtained results may be to the examined patient. It is of optimum significance that clinicians or medical practitioners express an extension of concern and regards about patients.

• Standards for Health Professionals

The standards are a reflection of minimum requirements that are expected to bring about a professional-based fitness-to-practice standards designed to give patients maximum protection. Thus professional standards are needful for uplifting the fundamental requirements for individuals, professional-bodies, and for special institutions that could have health care interests.

“Professional standards often supplement regulatory standards, or they can be an alternative to statutory regulatory standards where no statutory regulatory body exists”.

An illustration of this is an instance has to to with the regulation of staff through a statutory mechanism (like general-medical-council-for-doctors, and the-nursing-and-midwifery-council) which could gain professional standard supports like the kind delivered by national-occupation-standards. The benefit of this structure is that it makes available professional services to the patient. In any case, the workability of regulatory agencies is also kept on monitor. This is achieved using regulatory councils whose primary interest includes:

• Protection OF public-interest;
• Promotion Of Best-Practices In Regulation, And
• Progressive regulations FOR excellence IN the health care professional.

• Evolution of Health Care

Health care in the U.S. took off from a minor system whereby healthcare remedies where carried out at home through the services of itinerant-doctors who had minor trainings in the healthcares. The evolution absorbed the acceptability of ‘germ-theory’ which was professionalized by doctors in curing ailments.

Conclusion

Safety of patients is becoming a more pronounced theme in delivering healthcare services in recent days. This of course is not surprising based of the fact that the healthcare sector; pharmacy, nursing, and medicine has had a close watch on ethics in the fore of practice as a new dimension to bringing about better delivery to the patient. Also, only recently, there is an increase in the awareness of consequences of failure to be practical in the adaptation of ethical imperatives. There is a general awareness of the technique which is employable in bringing about realism to the noxious ideal of not preventing harm in healthcare practices. This paper discusses Connecting Moral Agency and Patient Safety in HCE: Justifying the Shift of Focus from Blaming Individuals for Medical Errors to Developing Systems for Patient safety.

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