Have you ever tried to respond when a friend or relative who doesn’t work in health care asks, “Is health care safe?” Do you feel embarrassed? Apologetic? Defensive?
Recently I exchanged emails with a colleague from the financial world who’d read the August Consumer Reports story on hospital safety ratings. (“How safe is your hospital?”, available at www.consumerreports.org/cro/magazine/2012/08/how-safe-is-your-hospital/index.htm#What_we_found.) Only 18% of U.S. hospitals were rated in the categories of infections, readmissions, communication,
overexposure to computed tomography scanning, complications, and mortality. Most of these topics are familiar and unwelcome subjects in our own dialogue. We’re programmed to respond to such ratings with a critique of the methodology (“insufficient risk stratification” or “unreliability of patient-reported data”). Or we smile, swallow, and acknowledge how important it is to have information that helps us improve our processes and outcomes.
My colleague wondered if perhaps there’s a business opportunity to help organizations improve safety and prevent adverse events. I cheerfully assured him organizations were chock full of initiatives, programs, performance improvement projects, scorecards, collaboratives, culture surveys, time-outs, crew resource management techniques, checklists, and (last but not least), posters boasting days without infections or falls. So the business space is pretty well occupied.
All joking aside, organizations and staff absorbed in these efforts are doing everything possible to keep patients safe. Still, we know it isn’t enough. Healthcare harm is the third leading cause of death in this country—an alarming, embarrassing, and shameful indictment. The Leapfrog Group (www.leapfroggroup.org/cp), which compares hospital safety scores, and the Centers for Medicare & Medicaid Services (CMS), which offers Hospital Compare, (www.hospitalcompare.hhs.gov/hospital-search.aspx?AspxAutoDetectCookieSupport=1), also give the public a glimpse into the perplexing maze of healthcare organizations.
With Consumer Reports’ enormous readership and longstanding credibility, its foray into hospital safety ratings might do more than raise eyebrows, possibly igniting a consumer movement that won’t tolerate the “Yes, but…” response any more. Its hospital safety report provides strategies to prevent or reduce harm if practiced consistently, as well as tips for consumers to assert their role in preventing unnecessary risks.
Whether we choose to refute or diminish reports that publicize hospitals’ abysmal safety ratings, the truth is health care can be dangerous. It’s an undeniable problem. For quite some time, we’ve had lists of events that should never happen, originally called “never events.” Yet we know these events still happen, albeit in smaller numbers.
As my colleague and I continued to exchange emails, I recited the mantra about reducing variation (a fundamental principle of performance improvement), concluding it all comes down to managing behaviors and performance. I ruminated over whether our military and veterans’ institutions get better results because they’re so much better at garnering expected performance without the rugged individualism that afflicts many of our organizations. He quickly produced a link to an April 2012 article, “Frequent errors make hospitals no safe haven for ailing patients,” from the Scranton (PA) Times-Tribune newspaper (http://thetimes-tribune.com/opinion/editorials-columns/guest-columnists/frequent-errors-make-hospitals-no-safe-haven-for-ailing-patients-1.1299683?localLinksEnabled=fals). Guest columnist John Hudanish, wrote that hospital errors “kill as many people as would perish if four jumbo jets crashed with no survivors” every week, or “nearly twice as many Americans…as were killed in action in the 15-year Vietnam War.” He added, “There are no recent studies rating military health care, but 15 years ago, the Department of Defense invited the Joint Commission…to rate our military hospitals. Defense Department facilities scored in the low 90s, about 30 points higher than the national average.” If this statistic is true, we’re continuing to ignore a seminal approach to curbing errors. Many experts suggest health care is 10 to 15 years behind other industries in addressing safe practices.
Getting back to the swoosh: The Nike® swoosh, symbolizing the company’s “Just Do it” campaign, not only triggered a renaissance within Nike but inspired consumers to seek healthier lifestyles through exercise (made easier and more attractive with Nike merchandise). The swoosh, which consumers instantly link to Nike, is still a formidable advertising force after more than 20 years.
We’ve deliberately focused our attention on patient safety issues and attempted to solve these problems since the Institute of Medicine’s 1999 report “To Err is Human.” We’re inching our way closer to reducing harm with tool kits, checklists, bundles, high-reliability organizations, and the backdrop of looming penalties. But maybe we need a daily reminder that inspires us to do the right thing without hesitation or deviation. It’s not our brains that need to understand more about safety. The problem is that our social interactions can break down, eroding the systems intended to make us perform safely.
So perhaps we should create our own swoosh. It could be a green cross on a silver shield to remind us of first aid and protection. Accompanying the shield could be an oath of duty to do all within our power to keep patients safe. This might evoke a pledge to patient safety, just as the stars and stripes of the U.S. flag evoke the words of the Pledge of Allegiance. It might just work.
Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN