The medical staff appoints a committee of doctors (usually the medical executive committee or professional affairs committee) to oversee the quality of care delivered by the members of the medical staff. Regulations also require that every hospital has a process to appoint doctors to a hospital medical staff based on documented credentials from training programs and other regulatory bodies. Therefore, hospital safety rests with the professional managers of the executive leadership team their level of commitment determines performance. While boards receive monthly or quarterly quality updates, which occasionally include a root-cause analysis of safety concerns, board members, who are volunteers, typically do not have the expertise to understand how complex hospital processes work or what to change when something goes wrong. But safety is something that a hospital’s board of trustees is ill-equipped to govern. For example, regulations require hospitals to appoint a quality committee of the board. Government accreditation requires legal structures to be in place to ensure quality and patient safety. This was even though patients who did have the virus would have intimate contact with caregivers and other patients during procedures and follow-up care. The leaders of the health system consolidated the program anyway, and mortality rates dropped.ĭuring the Covid-19 pandemic, we have seen instances where surgical staffs resisted universal Covid-19 screening for ambulatory surgery patients, worried it would result in delays (and deferred fees) if testing revealed asymptomatic cases. The heart surgeons and other doctors practicing at the hospital that was going to lose the procedures complained that the hospital’s reputation would be tarnished and would negatively affect their individual practices. (It is well known that volume of heart surgeries is directly correlated to outcomes.) The health system’s administration decided to consolidate the programs and have the same surgeons do all the surgeries at one hospital. When one of us (John Toussaint) was CEO of a large health system, heart surgery was performed at two hospitals, neither of which met the case volumes to achieve the highest quality of care. Since there is no central system of accountability, hospital leaders have little imperative to assure clinical practice is based on the most up-to-date evidence.Įconomic and emotional factors can also hamper safety if hospital leaders allow it. Unfortunately, few have embraced the strategies of the best hospitals. Hospitals that are quicker to incorporate evidence-based medicine perform better. Research suggests this can take up to 17 years. Variation is partly due to the time it takes to implement evidence-based medicine research. Why do these risks and variations persist? Patients are 18 times more likely to suffer a bloodstream infection from a central venous catheter when treated at poor-performing hospitals.Įxisting processes such as Joint Commission Surveys, surprise reviews by the Centers for Medicare & Medicaid Services (CMS), internal improvement processes, and retrospective public reporting of safety by government and public entities have not worked to reduce variation. The top 10% of hospitals are 10 times safer than bottom 10%. There are even greater differences in safety. This includes a 2.3-fold difference in heart attack mortalities. Across the United States, on average, patients are twice as likely to die in the lowest-performing hospitals. We outline below necessary steps to change this.Įven in geographies that have a reputation for high quality care (such as metropolitan Boston and metropolitan New York) there is a five times greater chance of death from acute myocardial infarction (heart attack), depending on the hospital one chooses. Still, an estimated 1.2 million are harmed each year by medical errors made in U.S. In the 21 years since the National Academy of Medicine published To Err is Human, there has been significant effort to improve safety and reduce the variation in health outcomes in the United States.
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