Not long before he retired from the top post at the Joint Commission, Dennis OLeary suggested that those entering a hospital should bring along a friend to help keep them safe from harm. Most people in healthcare would agree with OLearys warning. Weve all heard the stories about rampant infections, wrong-site surgeries and injections of the wrong drugs. The accumulated weight of such stories is lowering the publics image of healthcare.
The hope is that things are changing, if not fast enough. Lucian Leape, the veteran health policy researcher whose landmark 1991 New England Journal of Medicine study, The nature of adverse events in hospitalized patients, served as a call to arms on medical errors, noted as much in a recent interview with the journal Health Affairs. Leape was one of the first to suggest that the way the healthcare-delivery system is designed accounts for the problems that lead to poor quality and unsafe care. Leape feels that patients hospitalized today are safer than they were in 1991, and progress is accelerating.
Leape points to the Institute of Medicines call to arms in 1999, the work of the Agency for Healthcare Research and Quality and the National Quality Forum and the Institute for Healthcare Improvements 100,000 Lives Campaign, as a sign of the kind of systemic change he has advocated.
Leape isnt so kind to the federal and state governments. He gives state and federal governments a resounding F on quality. He claims that the federal government has done little to provide incentives, financial or other, to improve safety. States have required hospitals to report data to the public, but he doesnt believe that is a powerful enough incentive on its own to force change.
On the other hand, he thinks that public reporting may have some long-term value by forcing hospitals to take a long, hard look at their records on infections and errors. Though nobody will pay them to make changes, acknowledging mistakes when they occur, fully explaining what happened, apologizing for errors and providing compensation for the cost of the injuries we cause are things that we have to do, he said. For too long, too many doctors and nurses have not been forthcoming and honest with patients when things go wrong. Just as patients sometimes accuse, there has sometimes been a conspiracy of silence.
He believes also our current system for paying for healthcare is rife with perverse incentives. He makes his point with this anecdote: A doctor does a good job treating patients with asthma, teaching them to manage themselves, and the end result is exactly what we wantpatients have fewer attacks. They are not going to the doctors office as often, they are not going to the emergency room, and they are not being admitted to the intensive-care unit and being intubated. But the net result is that both the doctor and the hospital lose money. That does not make any sense, and we need to change that.
Leape says the most disappointing thing for him in the safety movement is that chief executive officers and other hospital officials have not made safety a priority. That wont change unless boards of trustees of hospitals and other healthcare organizations make patient safety their concern.
His conclusion is chilling: Most people do not believe that truly safe care is possible, that it is possible to eliminate medical injuries. ... Clearly, we are not going to give improving patient safety the effort, the enthusiasm or the money that is needed unless we believe it is possible to really make healthcare safe.