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Last year there wasn’t a single fatal airline accident in the developed world. So why is the U.S. health care system still accidently killing hundreds of thousands? The answer is a lack of transparency.
But these are adjustments that can be made, and made all the more fairly and definitively the more data we have about just who is receiving what treatments and with what results. In no other realm—certainly not any as inherently dangerous as health care—do we accept the argument that meaningful comparisons of results are impossible just because those being compared face somewhat different circumstances. Some airports have shorter runways and are more congested than others; some have to deal with frequent snow or thunderstorms, nearby mountain ranges, or lakes and rivers that attract unusual numbers of flocking birds. No two are exactly the same. Yet we don’t therefore conclude that there is no point in comparing the safety record of one airport versus another, much less say that it is acceptable for a certain number of people to be routinely killed on approach or takeoff. We demand that all airports, and everyone else involved in aviation, do what it takes to get accidents to as close to zero as possible, and that they use reams of performance data to make that happen.
Moreover, it’s not just the outputs of different health care providers we are concerned with, but their inputs as well. You say many of your infected patients are coming from nursing homes? Why not hold them to higher standards? Why are you not doing what the Pittsburgh VA is doing and testing all your patients for infection before they get out on the wards? Why don’t you have sensors in hospital rooms, as some hospitals now do, that sound an alarm if anyone exits the door without having first washed his or her hands? For that matter, why not take up the suggestion of Paul O’Neill, the former treasury secretary who pioneered industrial safety as CEO of Alcoa and is now a leading voice on patient safety: have a big sign posted at the front door of the hospital, as nearly all factories and construction sites do, that reminds workers as they come on each shift just how many days it has been since the last medical error or hospital-acquired infection? In short, just exactly what have you done to promote a culture of safety?
Experience has shown that when hospitals and doctors can answer that question forthrightly, and when they are open and honest about their mistakes and show they are taking steps to fix them, they are much less likely to face malpractice suits. In 2004 the University of Illinois Medical Center in Chicago began flagging cases of harm and unsafe conditions that could cause injuries—up to 7,000 reports a year. It also began admitting and apologizing for its mistakes, conducting investigations of harmful incidents that are open to patients and their families, and even offering financial compensation when necessary. The program has lowered the number of malpractice claims and the amount of payouts, while increasing trust and leading to hundreds of patient safety improvements. The hospital’s methods boil down to what any one of us would instruct a child to do when he makes a mistake: stop making excuses, and take responsibility. The facility is now considered a national patient safety pioneer, and its methods are being expanded through a federal grant to nine other hospitals in the Chicago area.
This is what current best practices in patient safety look like. They could be even better if consumers and medical experts had the data they need to determine each hospital’s progress in promoting safety. We know this works in other inherently dangerous industries. Why should health care be an exception?
We all understand that medicine is increasingly complicated and that hospitals are increasingly filled with patients who would have died years ago were it not for the wonders of modern medicine. But the Hippocratic oath says, “First do no harm.” Precisely because health care is becoming more and more complex, and therefore inherently dangerous, it will continue to cause more and more and more deaths and injuries until we put safety first.