Improve Reporting for Patient Protection

About PreP 4 Patient Safety


This section introduces hospitals and other health care organizations to CAC's PreP 4 Patient Safety Pilot Project.

About PreP 4 Patient Safety

Click on this button to go to the PreP Web Site:      to access complete information about the Program.  The PreP Web Site Address is:

The Relationship Between Mandatory Reporting and the PreP 4 Patient Safety Program 

PreP 4 Patient Safety aims to institutionalize information sharing between hospitals and licensing boards when one or the other of these entities identifies a practitioner whose performance is below an acceptable standard of quality and recommends remedial actions, such as targeted education or mentoring.  Most states already have statutes that require hospitals to report to licensing boards when they take an adverse action that results in termination or significant restrictions on practice privileges.  Federal data banks administered by the Health Resources Services Administration have similar reporting requirements. 

PreP 4 Patient Safety will not affect these mandatory reporting requirements.  Rather, it is designed to trigger communication among hospitals, licensing boards, and those practitioners who (1) have some clinical skills or knowledge deficiencies, (2) have not to this point caused patient harm or committed acts that would subject them to a licensing action, and (3) who could benefit from an appropriate educational intervention.   

PreP 4 Patient Safety strives to change the current climate in two important ways.  It fosters trust between hospitals and regulators and it helps clarify the distinction between the PreP 4 Patient Safety early intervention and remediation cases and the more serious cases that trigger state and/or federal mandatory reports.  These two changes can be expected to result in more hospital cooperation with mandatory reporting requirements and in more early interventions.  By preventing errors and patient harm, the increase in early interventions should, in the long run, reduce the number of instances in which mandatory reporting becomes necessary. 

Dr. Lucien Leape believes PreP 4 Patient Safety “has immense potential to significantly improve both the boards’ and the hospitals’ processes.”   A leader of the “systems safety” movement, Dr. Leape said of PreP 4 Patient Safety, 

Performance problems are systems problems, too.... Lack of effective methods of identifying and dealing with marginal performers is one of the most important “latent errors” or “systems failures” we have in health care - every bit as important as the other ones we talk about....  Hospitals need to develop much better mechanisms for identifying problem practitioners before they harm patients.  There need to be internal standards, effective monitoring, and early intervention - at levels lower than “actions.” 

Former President of the Federation of State Medical Boards, Dr. George Barrett praised PreP 4 Patient Safety as an impetus for creating “the infrastructure for ongoing assessment and education.”   

Hospitals at times identify but fail to report physicians whose problems do not rise to the level of suspension or restriction, instead suggesting they would benefit from additional education, training, or proctoring.  This has created an environment that fails to protect the public.  Under (PreP 4 Patient Safety), hospitals would agree to inform licensing boards of every intervention to upgrade skills and knowledge, and boards would agree to inform hospitals when a physician with a problem is brought to the attention of the board.   

California Medical Board Executive Director, Ron Joseph concurs that rather than being entirely reactive, licensing boards “can, and should, be participants in finding proactive measures designed to forestall medical error.”  

Hospitals wishing to learn more about the operations of PreP 4 Patient Safety programs are encouraged to contact CAC, or their medical board in states with an operating PreP 4 Patient Safety pilot program.

Click on this button    to contact the Citizen Advocacy Center (CAC) via e-mail or telephone.  The CAC Contact Information Web Page is: 

Each section of this web site provides information to facilitate outreach activities.  This section also provides an opportunity to learn about CAC's PreP 4 Patient Safety pilot project.

Last Updated: February  2004  |  About the Pilot Boards  |  Site Map  |  Online Question Form