WASHINGTON, D.C. — A word for hospital Chief Executive Officers, or those who aspire to run businesses that take care of patients: make it very personal.
The CEO job, especially in complex general acute care hospitals is changing and it will change even more as we shift to value-based reimbursement, population health management and deficit reduction. Hospitals will be asked to do so much more with so much less. The “so much more” part that I am referring to is dramatically improving patient safety. With estimates of preventable hospital deaths ranging from 150,000 to as high as 440,000 a year, and deaths due to hospital acquired infections now topping 70,000 a year, what we are doing is clearly not working.
But, before the quality of care gurus with their pie charts and needlessly complex PowerPoint slides mount a verbal assault, hear me out. I get it. I know this is a complex problem. If it were easy to solve we would already have made a huge dent in the preventable death numbers given the hundreds of millions of dollars invested, but we haven’t. In fact, patient safety gurus believe that preventable death numbers are growing, so, what are we not doing to protect our patients?
There are a lot of hospitals that are redoubling efforts to improve – for example, morning LEAN rounds at Greater Baltimore Medical Center where the first question CEO Dr. John Chessare asks his leadership team is whether any patients were harmed in the previous 24 hours, and also were any employees injured. Then they go through the rest of the measurable categories looking for glitches that could conceivably impact patient care, from supply chain issues to staffing. Dr. Chessare is not the only LEAN big believer who is putting out a lot of daily energy and focus to protect patients. However, when you look at the number of US hospitals that mirror this effort, the Greater Baltimore Medical Centers of this world are in a woeful minority.
A former successful east coast hospital CEO turned strategic advisor agrees that our focus on quality and safety is missing something, and it is not money. “We seem immune to the tragedy that someone’s mother, father, husband or child died in our care, the result of a mistake that should not have occurred. We treat this as an unfortunate reality of working in a hospital,” he said. If that fails to assuage the pain, he added, defenders of the status quo – and that is what they are – claim that although the number of preventable mistakes is large, they are not statistically significant when you think of the huge number of “patient touch” events — the opportunity for mistakes to occur — that occur every 24 hours in hospitals. But that is just an excuse dressed up to sound like a plausible excuse.
Which brings me back to my earlier question: so, what are we NOT doing to make this problem better?
We are NOT making it personal. The numbers of preventable deaths are just numbers. We don’t like that there is a problem but we have no emotional connection. Secondly, we do not seem to consider that fixing this is a moral imperative. The emotion, passion and personal accountability are being filtered out by the science of process improvement.
Soviet dictator Joseph Stalin, who was responsible for killing more than 20 million of his fellow countrymen, said that one death is a tragedy, 20 million deaths is a statistic.
By that standard, my mother was a mere statistic.
For me, it is very personal. She died because of a preventable mistake in her hospital care – someone left the bedrail down and failed to turn on the bed alarm. She fell during the early morning hours on the day she was to be discharged, fracturing her hip. Surgery followed 12 hours later and she never recovered. Weeks later she died peacefully in a magnificent hospice, but before she got to that point she suffered mightily. And, for the record, the additional cost to Medicare was significant for an event that should never have occurred.
We did not sue. Medical malpractice litigation does nothing to ensure that patient care will improve. When you go to the courthouse, it is just about the money. If anything, that approach drives the problem deeper underground.
CEOs and their leadership teams need to make eradicating mistakes a deeply personal commitment, in every meeting, in every interaction with nurses, ancillary personnel, and everyone else who gets a paycheck. They should also consider it a moral imperative to protect patients at every point in the process.
© 2019 John Gregory Self