An interview with Dr. Peter Gausmann, Managing Director of GRB Gesellschaft für Risiko-Beratung mbH (Ecclesia Group).
Challenges of Traditional Patient Education
How would you evaluate traditional patient education, and from your perspective, is it still contemporary?
Gausmann: Traditional patient education using written consent forms is functional if conducted properly and complies with legal requirements. However, the question of whether it is contemporary is a different matter. The challenge is to adapt education methods to the changing needs and expectations of patients and potentially integrate modern technologies to make patient education more effective, contemporary, and understandable.
What technical possibilities do you see in this regard? In what direction could it become more contemporary?
Gausmann: The problem, which is scientifically documented, is that patients often forget what was discussed with them shortly after the education session. A proven solution is to create informative videos about specific procedures that can be accessed, for example, through QR codes, to provide patients with a visual understanding of the planned procedure. In addition to this, it is important to enrich traditional consent forms with comprehensive information. This not only allows patients to sign the form but also provides them with a detailed information package that they can review later according to their individual capabilities.
What tasks should decision-makers in legislation address now to improve patient safety in education? What new standards are necessary?
Gausmann: The legal situation is initially clear: causing bodily harm to a patient without consent is unlawful. However, once the patient has been informed about the risks and, after weighing the pros and cons, gives consent to the planned procedure, this process is legally correct. It is essential to be able to prove this retrospectively, especially in light of potential claims from patients. These claims could involve the patient alleging insufficient information about the risks that subsequently materialized.
From a legal perspective, it is crucial that the patient's consent is based on a well-founded information basis. This requires capacity for consent, meaning that the patient must not only be cognitively capable but should also have an understanding of the situation. This necessitates an individualized approach that takes into account the specific risks and the patient's cultural context. The existing legal framework can be further developed, particularly concerning the customization of the education process.
Digital Solutions and Their Contribution to Patient Safety
Considering the rapid developments in healthcare, what new approaches do you see for clinical risk management in terms of patient safety?
Gausmann: Patient education is an important pillar of clinical risk management. It is crucial to distinguish between clinical risk management and patient safety management. The latter goes beyond risk assessment from the perspective of insurers and has a broader perspective. A central aspect of clinical risk management is a proper and individualized education system.
Since 2021, the WHO has been calling for continuous improvement in patient safety as part of the "Global Patient Safety Action Plan." This includes greater patient involvement in patient safety and the creation of high-reliability organizations that implement certain safety measures with the highest assurance. Patient education is an integral part of these safety efforts. Additionally, there is a list of so-called "Never Events," events that can be 100% avoided if appropriate preventive measures are taken. These include, for example, operations on the wrong limb or the mix-up of blood transfusions. Some of these "Never Events" are directly related to patient education. To improve these, one should align with the requirements of the "Global Patient Safety Action Plan" and the "Never Events."
How do digital solutions like medudoc contribute to improving patient safety?
Gausmann: Patient education indirectly contributes to improving patient safety. I would not claim that it has an excessively strong influence on its own, but medudoc can help strengthen the health and risk awareness of patients. Individualized education promotes both health and risk awareness. This, in turn, leads patients to better understand and internalize their duties of cooperation. A well-informed patient tends to show a higher willingness to cooperate, which can enhance overall safety.
Do you see advantages in digital education and documentation compared to the traditional paper-based method, especially in terms of hospital workflows and the work of doctors?
Gausmann: Yes, I definitely see advantages in digital education and documentation. Legally speaking, well-created, digitized education has the advantage that it can be accessed from various locations – both from home by the patient and by medical professionals through the electronic health record (EHR).
This digital integration significantly improves hospital workflows because doctors and medical staff can conveniently review education information to ensure it is complete and up-to-date. Furthermore, education can be digitally integrated into the workflow, and automated checks can ensure that education is properly conducted before a procedure begins.
This contributes to increasing patient safety by considering it as an integral part of the entire care continuum – a requirement emphasized in the Global Patient Safety Action Plan. Thus, digital education is not just a single element but a significant step toward comprehensive patient safety.
Patient Participation and Understanding
To what extent can better-informed and prepared patients contribute to a smoother treatment process?
Gausmann: Better-informed patients are able to better understand and fulfill their duties of cooperation. Education always includes the patient's responsibility to make certain preparations, such as fasting. As a result, patients come to the clinic better prepared. This is particularly important in the context of increased outpatient care and will significantly facilitate the process of outpatient medicine.
Do you know of any examples where lack of information or insufficient preparation has compromised patient safety?
Gausmann: Yes, this includes, for example, not adhering to fasting requirements, which in the past has led to cases of aspiration pneumonia. Insufficient preparation for a colorectal surgery procedure is also a problem, including bowel preparation and other preparatory measures. There are many aspects where inadequate preparation in the home environment can lead to problems, especially regarding infection prevention and hygiene. Procedures often require a temporary or permanent change in lifestyle, as in the case of patients receiving gastric bands. Therefore, comprehensive education not only about the risks but also about appropriate behavior in such situations is of great importance.
Legal Protection and Documentation
How do you assess electronic documentation and signatures in terms of legal protection for clinics and doctors?
Gausmann: From my non-legal perspective, I can say that I personally sign many documents and transactions digitally today. As long as it is traceable in the background who did what, and the technical measures ensure that I can verify at any time who, when, and how the patient was informed and whether the patient legally signed the consent, I see no problem with it. While data protection is of utmost importance in this context, I believe that sometimes we hinder progress in digitalization due to these concerns. However, in this case, it seems to have been implemented.
To what extent do digital documentation and signatures contribute to improving patient safety? Is that the case at all?
Gausmann: The approach to patient education is undoubtedly useful, especially when it is practised comprehensively. This means that the consent form is individualized, tailored to the patient's needs, and possibly supplemented with visual aids. In this form, patient education can become an extremely valuable tool when carried out thoroughly. However, it is important to note that many doctors find patient education burdensome. Personally, I always advise my students and aspiring medical professionals to view patient education as an opportunity to communicate with their patients. Instead of considering it a tedious legal obligation, they should see it as a chance to spend meaningful time with their patients, alleviate their fears, inform them about risks, and at the same time ensure legal security.
Patient education offers the opportunity for effective and structured communication between doctor and patient. With modern approaches that include technology and individualization, we can further enhance the quality of this communication.
Given the traditional practice where doctors make handwritten adjustments to consent forms to document individual counseling sessions, the question arises: Is this approach still contemporary?
Gausmann: These consent forms were not created arbitrarily; they were developed due to their certain complexity and legal validity. They structure the informed consent process by covering the indication, general risks, and specific risks.
However, the question of whether this approach is still contemporary can be answered in two ways. On the one hand, it is contemporary because, in many cases, it is the only available means. On the other hand, one could argue that it is no longer contemporary because more efficient systems are available today that can assist healthcare professionals in their work.
What is your vision for the future of patient education?
Gausmann: Patient education should primarily be comprehensive, understandable, and tailored to the individual patient. It is crucial to raise awareness of health and risks and, thus, have an educational impact on the patient. Ensuring legal security is seen as a result of this comprehensive and educational approach.