LA GRANDE, Oregon — They say that politics is a contact sport. In reading newspapers and watching news programs, that statement today should be categorized as a blinding flash of the obvious. All the norms of effective leadership seem to no longer matter in certain circles. Everything seems to be more about ideology and the trickle down impact on the quality of national leadership is troubling.
We also seem to be having a leadership challenge in healthcare. We continue to struggle — mightily — with issues of quality of care and patient safety. We have invested hundreds of millions of dollars to improve with little or no gain. Preventable deaths in hospitals number about 700 day. It is the third leading cause of death in the United States, according to a January 2017 article New England Journal of Medicine Catalyst that explored the impact of such mistakes on nurses, physicians and other members of the team.
To put this in perspective, the number of people — fathers, mothers, sons, daughters — who die every day from a medical mistake that could have been prevented is the equivalent of two Boeing 777 airliners crashing every day, of every week of every month… And all souls on board are lost.
This not a new phenomenon. Several years ago I reported on this issue in a speech before a large medical group. This was right after the updated numbers had been reported. After using the airliner analogy I paused. There was no reaction. No gasps. No looks of surprise or horror. People just stared straight ahead as if to say, ‘Yeah, we know there is a problem. We are beyond being shocked.’ Therein is part of the problem. We are numb.
I gave the same speech a few months, later in a keynote to a medical group in Las Vegas. This time, determined to get the attention of my audience, I made two changes to the presentation. After presenting the findings on the escalation in preventable deaths, I added a picture of Joseph Stalin with this quote: Comrade Stalin once said that one death is a tragedy, a million deaths are but a mere statistic. A slide of my mother’s grave stone faded into view. She had been the victim of a medical mistake. I turned and said, “Mom I am so sorry. I guess you are but a statistic.” This time there were audible gasps from the several hundred in the crowd. After the speech, dozens of people came up to thank me for making this issue personal, for making it real to them. Throughout the day I received numerous compliments on the speech and thanks for raising this important issue. There was only one complaint.
At noon, a man who identified himself as a hospital CEO chastised me in no uncertain terms, not for my talk, which was largely about leadership and the impending transformation of healthcare, but for including the issue of quality and the horrifying issue of preventable deaths from our care. I remember his words as if they were uttered yesterday: “That was totally inappropriate. You should not be talking about that issue.” When I asked him if he believed preventable medical mistakes was, in fact, a problem, he agreed but argued loudly but that it was not appropriate to discuss in public, even at a meeting of healthcare leaders. I asked him if he was about ready to retire. He said he was. My response, thought, but not said, was good.
Last year, while having drinks with a friend who happens to be a hospital CEO, I shared that story about my speech, adding that I felt hospital CEOs had to do more to create an atmosphere in which quality and safe care are the top priorities of the organization and its culture. He said no, arguing that quality and safety are more the responsibility of the medical staff. I disagreed.
With more and more physicians employed by hospitals, this is leadership and cultural obligation that a CEO cannot delegate to the Chief Medical Officer.
One of the critical norms of leadership is accountability and that starts at the top. Health system CEOs, and anyone who leads a business that delivers healthcare services to patients, need to make creating a culture of accountability for quality and safety job #1.
This is more than a corporate goal for a CEO. It must be a personal one.