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28 October, 2015 Posted by John G. Self Posted in Healthcare

In Harms Way… Again

Posted October 28th, 2015 | Author: John G. Self

When hospitals choose higher margins/EBITDA/growth in earnings — whatever you want to call it— in exchange for bare-bones staffing that results in harm to patients, I have concerns.  Patient care and safety should not be penalized because hospitals are willing to cut corners at any cost.

in harms wayThe following example is not hypothetical, or a story crafted from whole cloth to produce dramatic effect.  It illustrates what happens in hospitals every day across the country.  It was reported in the Modern Healthcare online edition story dated October 24.  Not only were the facts shocking but it was the kind of event that invites greater regulation and union organizing efforts.

Here are the facts as reported in the article, that have ignited my frustration:

Last March, a nursing assistant noticed a large pressure ulcer on the backside of a patient needing intensive care at the Hazard (Ky.) ARH Regional Medical Center. It was about 10 days after the patient had been admitted for leg ulcers and complications related to diabetes and renal disease.

But on the day the sore was reported, the patient had been lying in one position on top of a bedpan for more than a day. The pressure from sitting too long in one position with limited blood flow had caused a large blister that covered the patient’s entire buttocks.

A federal investigation found the patient may not have been moved for “an extended period of time” because the hospital, part of the not-for-profit 10-hospital Appalachian Regional Healthcare system, was understaffed. Its policy required one RN for every six patients in this unit where most patients required intensive care. But that day, one registered nurse was caring for about a dozen patients, while the certified nursing assistant on duty had 14. Experts say it’s physically impossible for one nurse to attend to that many very sick patients.

In April, the CMS placed Hazard ARH in “immediate jeopardy” of losing Medicare funding due to failure to provide adequate staffing. That status was lifted in May. The hospital did not respond to requests for comment for this article.

Quality of care and patient safety are serious issues for our industry.  Many thousands of patients die every year in hospitals as a result of preventable mistakes.  Our industry has spent hundreds of millions of dollars trying to address quality and enhance safety without much success.

Hospital leaders have one of the toughest jobs in America today.  Hospitals are complex business models but that does not mean that good service — which includes giving quality care in a safe environment — is such a complicated problem.  You cannot say you have good service if your quality and safety numbers are low.

Patient care horror stories have become far too common and I fear that we have grown cold and indifferent to the sort of suffering and nonsense that only invites more regulation because the federal employees charged with overseeing this issue, the people we apparently love to hate, do not trust us to police ourselves.  For patients to be placed in harm’s way for reasons that are purely financial is not acceptable.  We should be outraged.  Patients come to the hospital trusting us to take care of them to the best of our ability.  Surely, putting the numbers first no matter what, is not worth breaking that trust.

© 2021 John Gregory Self


  1. JK says:


    I understand your comments and as a previous hospital admistrator and current medical group administrator, I can say that safety and quality has always been at the forefront of my decison making process. Let’s not forget that it is becoming more difficult to find and hire qualified RNs, LPNs and Certified Medical Assistants who want to work the floor. Especially in rural areas. Many graduate and immediately gravitate toward adminstrative duties or large city locals. Those of us who have worked in rural America know all too well how difficult is is to fill all the personnel vacancies with qualified staff.
    In reference to your post, the hospital should have closed beds and diverted patients if they didn’t have the staff to provide safe, quality care. The bigger problem is graduating more nurses who want to work the floor and in rural areas.

  2. Dan Ford says:

    I commend this post about the unfortunate infection, John. Preventable harm happens way too often as we all know. I commend you also for having the courage to talk about this in the spirit of doing what is right for the patient, as well as for staff, as well as for your clients. When I was active in health care executive search I was cognizant of not shooting myself in the foot as regards public comments about patient safety in the eyes of our clients or potential clients. Over the years, I became more vocal about patient safety as a challenge/encouragement to industry/hospital leaders. I know of only one experience where it cost me a search. That was okay, my personal mission was to plant seeds of constructive change as regards patient safety, in addition to search responsibilities for the client. It did not get in the way of search…rather, it enhanced my/our ability to represent our clients in a positive way and recruit strong candidates who also have a passion for patient and staff safety. CEO’s and everyone in health care always need to do what is right for the patient…it’s not always easy but, as Dr. John Toussaint from the ThedaCare Center for Healthcare Value in Appleton, WI suggests: “How can we provide quality care if we do not provide care from a baseline of safe care.” Keep up your good work! Search consultants also need to be authentic. CEO’s who want a search consultant with a genuine, personal passion about patient and staff safety will continue to ask you to represent their hospital in key searches.

    • John G. Self says:

      Dan, you are a kind and gracious man and someone I am honored to call friend. As a search consultant, you were someone I admired and with good reason.

      My dad always told me to do the right thing even when no one is looking. Perhaps that is what drives me to speak out. I try not to think about the new business consequences of my passion to champion great care and safe care.

      Several years ago, when presenting my recommendations for the CEO selection criteria at a small community hospital in southwest Texas, a board member asked why I wasn’t interested in becoming their CEO. I have to admit the compensation was very attractive but my better judgment prevailed and I tried to dissuade any serious discussion of this folly by saying, “Sir, I am like single-malt scotch. I am an acquired taste.”

      There are so many people much smarter than me that share our mutual passion for this subject. I hope those who read this post will ignore the messenger and join the growing chorus that, yes, we can and we must do better protecting our patients, that we must make it personal with every patient, every day.

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