USS 2016/2

Reducing preventable harm in hospitals

Each year, in the United States, millions of patients are harmed while receiving care in hospitals.
They get infections, experience adverse reactions to drugs, develop dangerous bedsores or come
down with pneumonia from the very ventilators meant to help them breathe.
The estimates of the number of people who die each year as a result of hospital errors have ranged
[5] from as many as 98,000 in a landmark Institute of Medicine report from 1999 to as many as 440,000
in a 2013 study.
It’s believed that most of these deaths could be prevented if health care providers always adhered
to evidence-informed practices. In recent years, the Centers for Medicare and Medicaid Services,
have sought to drive improvements by linking payments to hospital performance, including patient
[10] safety.
Amid the complexity, the chaotic pace and the increasing need for coordination, how can hospitals
do better to improve patient safety? How can they ensure, for example, that every single time a
patient receives a medication, precautions are taken to reduce the risks of an adverse drug reaction?
The big challenge is not just designing systems with better defenses; it is gaining acceptance for
[15] them, and properly implementing them. Over the past decade, for example, many hospitals have
adopted a key feature of aviation safety − checklists − to improve safety in areas where standard
protocols can save many lives, such as inserting central line catheters, using ventilators and while
performing surgery and assisting childbirth.
When the checklists are well implemented, the results of their use have been stunning. However,
[20] as checklists have proliferated, the results have been inconsistent, often because front-line
practitioners rejected them or adopted them halfheartedly. The devotion to protocol that pilots
see as integral to their professionalism is derided by some doctors as “cookbook medicine”. Atul
Gawande, a surgeon and contributor to The New Yorker, has said that the high value that physicians
place on autonomy and independence makes them reluctant to submit to checklists.
[25] So the big question is: how can health systems be made safer when success means changing the
attitudes and habits of health care professionals at a time when many are overwhelmed and deeply
frustrated by all of the demands being made on them? What does it take to get them to embrace,
with urgency, new ways of working?

opinionator.blogs.nytimes.com