To Err is Human and Primum Non Nocere
The interest for quality in medicine goes far back in time. Roger Bacon’s essay ‘De Erroribus Medicorum’ was authored in the 13th century and treats the issue errors made in medical treatment (Aas, 1991a). In the mid 1980ies, increase in malpractice claims in the US lead to talk about a malpractice crisis and malpractice claims were considered to represent only the tip of the iceberg (Aas 1991, a;b).
To err is human, but patients have a moral right to freedom from unnecessary harm. It is necessary to address the problem of how to improve patient safety. The phrase primum non nocere is well known from medical ethics. Today, an increasing number of healthcare organizations investigate adverse events (Nicolini et al., 2011). The belief is that by learning from the incidents, future adverse events can be avoided. Not surprisingly patient safety has become an own research area. Root cause analysis is a tool for investigation of adverse events (Nicolini et al., 2011). It includes collecting the facts, study of the work process, analysis, search for causes, reporting of the adverse events, work for change and evaluation of made changes.
Quality and Organization
Patient safety is a part of the quality problem. Health service quality can have three aspects: professional quality, quality as perceived by patients and management quality. In continuous quality improvement, both health personnel and leaders participate in the process, have a basis in reliable information, are actors in a quality promoting culture and quality promoting organizations, for example, multidisciplinary teams and learning organizations (Moumtzoglou 2003; Ovretveit, 1992). Organizational culture can be focused on flexibility for change to improve quality and less on a bureaucratic culture focused on keeping power by top down policies, for example by inspection and standard setting for lower levels (Ovretveit, 1992).
Organizational interventions are argued to be especially promising for providing solutions to the patient safety problem (Benning et al., 2011a).
Organization and Telemedicine
For realizing benefits from e-health, the importance of the organization should be explored. From Norwegian telemedicine projects, numerous publications have shown many organizational consequences and many types of organizational consequences (Aas, 2007a;b). For some years, we have seen that the work of several authors, based on samples from different countries, confirm and corroborate the findings of the Norwegian projects. We are dealing with verification of the findings from Norway (Aas, 2011a). Organizational consequences of telemedicine seem quite independent of country. For the future of telemedicine, organizational factors are fundamental.
Organizations implementing telemedicine should plan for organizational changes. It is important to be aware that organizational problems are not just problems, but problems to which solutions can be designed (Aas, 2007a;b).
Purpose of the present chapter: To explore the potential role for patient safety of a telemedicine network organization with centralization and decentralization taken into consideration.