Hospitals and their staffs are generally pleased with their efforts to improve patient safety, according to a recent survey from the U.S. Agency for Healthcare Quality and Research (AHRQ). Unfortunately, there's plenty of other research to suggest there's been virtually no progress in curbing medical errors and other threats to patients over the past decade.
In other words, hospitals are feeling better about doing... well, if not less, than far less than they ought to be.
Seventy-five percent of respondents to the 2011 AHRQ survey on patient safety culture gave their institutions high grades. Twenty-nine percent said their efforts were "excellent," and 46 percent said they were very good. About 1,000 hospitals and 472,000 hospital staff members, including physicians, nurses and administrators, responded to the survey.
Eighty percent of respondents said "teamwork within units" was effective in promoting patient safety. Management expectations and support were also highly rated. Overall, two-thirds of respondents had a positive view of patient safety in their hospitals. And amazingly, about half of the respondents said there had been no significant safety events reported in their facilities in the past 12 months.
We need to talk
To the extent that the survey elicited any negative feedback about safety, it was focused on communication problems. Only 58 percent of respondents thought there was good teamwork between different units within the hospital, and 45 percent expressed positive views of patient handoffs and transitions of care.
In an even more revealing finding, just 44 percent said that their hospitals had a "non-punitive response to error." The prevailing academic view is that medical error reduction requires a non-punitive approach so that mistakes will be reported and their root causes discovered. Guess why so many hospitals said no major errors had occurred in the previous year?
The real deal
In fact, just the opposite is true. One of every seven Medicare patients who is hospitalized suffers harm during his or her hospital stay, and adverse events in hospitals contribute to 180,000 deaths a year, according to a recent study by the Office of Inspector General in the Department of Health and Human Services. In a single month, the OIG said, 134,000 Medicare patients had adverse events, and 44 percent of those were clearly preventable.
Robert Wachter, a professor at the UCSF Medical School and one of the leaders of the patient safety movement, says there's been modest progress in the field over the decade since the Institute of Medicine issued its landmark To Err Is Human report. Stronger action by the Joint Commission and other watchdog organizations, as well as pressure from malpractice insurance carriers, has had a positive impact on safety, he says.
It's too early to tell whether Medicare nonpayment for "never events" and other medical errors will make a mark. But the bottom line is that not much has changed.
Fear of lawsuits... and of offending doctors
The fear of lawsuits, of course, remains an important reason for the pervasive secrecy about medical errors in hospitals. But an equally significant problem is that administrators are often afraid to say anything to the doctors who provide their bread and butter.
There are some exceptions, to be sure: Advocate Healthcare in Chicago, for instance, has taken a very strong stand on safety, and some other hospitals have gotten their medical leaders to come down hard on doctors who don't wash their hands at work. However, there's a problem with a medical culture in which patient safety doesn't rank as the number one objective.
Unfortunately, that isn't likely to change as long as hospital administrators and their staffs publicly pat each other on the backs for a job well done, while hiding the truth that they're all aware of. The promotion of patient of safety shouldn't be a blame game, but it should be conducted openly, and the goal should be the protection of patients, not providers.
Image supplied courtesy of geograph.org.uk