Elderly couple with a nurseOriginally published in the South Dakota Medicine Journal August 2019 issue.

Stephan Schroeder, MD, CMD, CMQ
Medical Director, South Dakota Foundation for Medical Care

Health care is a complex, adaptive system where people, processes and technology intersect in a work environment.  A wide spectrum of unintended conditions can cause patient harm, and a systematic approach may help avoid adverse events and promote a culture of patient safety. Engaging patients, families and caregivers helps remind all providers to see individuals in need over merely diagnoses or case numbers.

Dr Stephan Schroeder, medical director for South Dakota Foundation for Medical CareThe concept of patient safety has evolved and accelerated over the past 20 years as health systems began to understand and implement changes to improve quality and eliminate errors.  The promotion of this change lies with individual providers, system leadership and, certainly, the patients, families and caregivers. Leadership can encourage all facility staff to openly address clinical information and data that may represent potential patient safety issues.  Transparency and compliance surrounding patient care can be approached through strong governance and medical staff support. Examples could include infection control, surgical services, medication safety and quality assurance.

To Err is Human (1999) demonstrated preventable harm and death occurring in health care settings. Crossing the Quality Chasm (2001) provided a framework for defining and improving quality health care and avoiding that harm.  It introduced the elements of safe, timely, effective, efficient, equitable and patient-centered care and offered guidance for leadership. The revival and emphasis on keeping the patient and family at the center of care is an important tool for quality improvement and innovation.

Patient Family Engagement represents a partnership and resource for improving patient well-being and outcomes. Threats to this process include communication breakdown, care fragmentation, medication error and unsustainable cost. The challenges of poverty, poor health literacy, unstable social environments and mental illness all require a team-based approach. These threats may be mitigated by encouraging patient, family and caregiver involvement.

Shared decision making is a collaborative process that allows difficult choices to be made together. Each patient’s values, beliefs and preferences play a role in medication options, alternative treatments and chronic disease management. The Agency for Healthcare Research and Quality (AHRQ) and many other organizations offer tool kits and resources for supporting this patient/provider partnership in making these shared, and often complicated, decisions.

Patient Family Advisory Councils (PFAC) are being formed to allow patients and caregivers to give input to providers. Patients in turn gain perspective on the challenges facing those providers in the delivery of healthcare. This dialogue offers a partnership to enhance the care experience and avoid unrealistic expectations from family members regarding their loved ones. Partnerships like PFAC may help clarify complicated situations and build trust.  When patients, families and providers have better understanding and engagement, adverse events can decrease and outcomes can improve.


The Great Plains Quality Innovation Network website offers a variety of resources and tools for patients and families on topics including immunization, medication safety, chronic disease self-management and more.