Patient Safety as Job One

Good for Medicare! It will stop covering claims that stem from preventable errors. [NYT, 19 Aug 2007]

Hospital administrators are screaming about more paperwork snarls. I agree. Paperwork will get worse. Definitions are mushy. Cheating—attributing adverse outcomes to nonpreventable causes—will take place. Willingness to admit errors will decline, even plummet.

While I acknowledge the problems associated with the new regime, and even acknowledge the severity of said problems, I can only say to my hospital administrator friends, "You asked for it!" Medicare is using a blunt weapon out of frustration. Hospitals are, in my experience, now focusing on preventable errors, no doubt of it. But there is an enormous gap between "focusing on" and becoming "fully devoted to." That is, there are now numerous patient safety "programs"—but few on the order, say, of American industry's 179-degree about face-strategic realignment on product quality in the 1980s. There is little doubt that we lose far more lives to preventable errors (like those that stem from the failure to wash hands carefully!) than we save via sexy new surgical procedures. I once told a group of hospital CIOs that implementing electronic medical records would allow them to save more lives than the entire surgery department—perhaps that's an exaggeration, but not by much.

So I pray on bended knee, especially as an "old guy," that such blunt instruments as the new Medicare policy will encourage, at gunpoint if necessary, hospital administrators to move patient safety off the "important programs" list and instead to the top of the "strategic survival right f***ing now" issues list—and keep it there until the problem is brought under control. Remember, the definition of "preventable" is "preventable"—and the bulk of the fix is not cost intensive. Recall how "quality is free" went from consultants' gag line to Holy Writ in industry—and turned out to be true.