The explanation for the lack of progress in improving safety in our hospitals is only a mystery for those who wish it to remain so (Modern Healthcare's Daily Dose, July 27).
Lucien Leape is quoted in the Health Grades report as acknowledging that he has not seen a "big improvement" in patient safety since the publication of the Institute of Medicine's report To Err Is Human five years ago. This despite the fact that, according to this same report, "The need to monitor, track, assess and improve the safety of inpatient care is at the top of many stakeholders' agendas."
There appears to be some dissonance in these statements-and there is. In reality, physicians and other healthcare providers who attempt to report and correct unsafe and inadequate care in hospitals and clinics are often attacked, labeled as disruptive, reported to the National Practitioner Data Bank and/or fired rather than being thanked and treated like the responsible professionals that they are. Worst of all, the problems that they sacrificed their careers and personal lives to correct often go unaddressed until injuries to patients result in legal action and the courts step in. Given such circumstances the explanation for the lack of progress in improving hospital safety is readily apparent. The solution to improving hospital safety lies not in developing more monitoring programs but in acknowledging and removing the obstacles that exist to improving care.
The practice of "medicine by conspiracy" is a national epidemic that is going unacknowledged and unaddressed, except for the courageous actions of determined individuals and rare organizations such as the Association of American Physicians and Surgeons.
The American Medical Association and the American College of Physicians, fixated on billing issues and regulatory battles, have steadfastly refused to support ethical physicians and other healthcare workers who have been fired for reporting human rights violations and inadequate care. Reviews by agencies such as the Joint Commission on Accreditation of Healthcare Organizations and the Justice Department are perfunctory.
No progress will be made in the effort to improve healthcare safety until the fear, hopelessness and cynicism that result from the present system of medicine by conspiracy are addressed.
W. Harry Horner
Don't forget the labs
Your story on building a clinical information system underestimates the significant role and contribution of medical laboratories to these systems ("The games doctors play," July 26, p. 32).
Lab results are at the heart of virtually every area of healthcare, including IT systems. Indeed, the Joint Commission estimates information from the lab constitutes up to 80% of the typical electronic medical record. Although approaches such as computerized physician order entry are getting much of the attention, laboratories will continue to supply most of the data upon which other elements of healthcare IT are based.
Lab automation and data
Headline not all right
I'd like to point out an error in the headline to Michael Romano's special report on children's hospitals ("The kids are alright," July 26, p. 25). "All right" is two words. Always. "Alright" is not an accepted variant. It's a common error, but not one I would expect Modern Healthcare to make.
Director of compliance and corporate ethics
Orlando (Fla.) Regional Healthcare
Editor's note: The headline and its spelling were borrowed from the rock band The Who, which had a song and a 1979 documentary of the same title.
Self-referral isn't competition
My healthcare system fully embraces competition in the delivery of health services; in fact, there are more than a few who would argue that we are at times overly competitive. Your criticism of the recent Florida legislation banning specialty hospitals and basing that criticism on the fact that "Modern Healthcare is a strong proponent of competition in the healthcare system," however, ignores the fundamental premise which drives the development of such facilities: It's not competition, it's physician self-referral ("Raining on competition," July 12, p. 20).
As we learned in Economics 101, the type of competition that delivers the benefits of high-quality, low-cost goods or services depends on informed consumers making independent choices in a free and open market.
A transaction between a clinically naive patient understandably under stress and a physician-owner of a specialty hospital consummated within the confines of the physician's office is the antithesis of such competition. There is, in fact, no transaction which is as essentially anticompetitive as a physician owner directing his or her patient to the single hospital in a given health market area in which that referring physician holds an economic interest. As the patient "chooses" a facility in which to receive medical services, "competition" between hospitals plays absolutely no role in the decision-making process.
Defend, if you will, the physician's right to make a lucrative financial investment, but please don't do so by any misguided notion that such an investment results in a "competitive" healthcare marketplace.
Senior vice president of public policy
Sioux Valley Health System
Sioux Falls, S.D.
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