Getting a handle on your institution's current policies
and practices on informed consent is a key step in planning
an improvement program. Some of this information can probably
be gathered from policy manuals and departmental procedures.
Samples of informed consent forms will also likely be easy
to retrieve from clinic files. An inventory of all forms
would be ideal. One-on-one interviews with departmental
heads, residency program directors, or other supervising
physicians may also be valuable. The main questions you
need to answer up front are:
What are our current policies, processes, and forms
for informed consent?
What needs to be improved?
Have problems with informed consent (eg, adverse events,
legal challenges) been reported within our institution?
Do our consent forms meet the needs of our diverse community?
What are the highest priorities?
How should we make improvements?
Who can help in this process?
How should we measure our progress?
Your interactions with colleagues as proposed in the previous
section, Prepare Your Organization, may present an ideal
opportunity to gather this type of information. However,
assessing clinician understanding and implementation of
your informed consent policies and forms may also require
a wider survey of staff or a broader series of one-on-one
interviews with nonsupervisory clinicians. Reviewing patient
files or making rounds with staff are other options for
gathering information about the current practices in your
facility. This could all be time well spent since it will
help you in prioritizing needs in terms of which forms to
create or revise first, which departments to train first,
or what process or communication skills to emphasize first.
Keep in mind that the question-asking itself can serve as
an early form of staff education and awareness-raising that
reminds them of the importance of informed consent. The
process may also create a “buy in” from clinicians
or administrators to follow-up and re-write problematic
consent forms or sharpen basic communication skills. In
fact, this planning step may allow you to identify a colleague
to “champion” the improvement effort (e.g.,
a chief of surgery? A nursing leader? A risk manager?).
A few specific suggestions for initiating the discussion
and information-gathering are listed here.
Developed with a grant from the Robert Wood Johnson Foundation