6 ways hospitals can address medical errors better
Despite the public's near-wailing about the difficulties of air travel, about 150 million boardings of commercial jets take place in this country in an average year. The reasons are simple: Air travel is critical to the economy, and the chances of your plane falling out of the sky are not nearly as good as winning the lottery.
Yet were the odds of dying in a plane crash about the same as experiencing a medical error, few would ever fly again. The airlines would be quickly litigated out of servicing whatever business remained.
Although just as crucial to the economy and overseeing far more life-and-death situations daily, the healthcare sector only pretends to manage its risk a fraction as well as the airlines. A new report by the U.S. Department of Health & Human Services (HHS) concluded only one in seven medical errors involving Medicare patients ever actually come to light. Inspector General Daniel R. Levinson observed that even when errors are reported, practices are rarely changed to avoid an encore performance.
In my home state of California, I am certain errors are grossly, if not criminally underreported. Since reporting "never events" that endanger a patient's life became mandatory in 2007, some hospitals have reported a half-dozen such errors or more. However, two-thirds of the state's hospitals have reported none at all.
Reducing rather than ignoring errors is a no-brainer for finance executives, as they cost hospitals huge sums of money. A drug error costs about $4,000 on average. At least 1.5 million occur every year, and many of them kill patients. A retained surgical instrument usually costs tens of thousands of dollars to correct. Hospital-acquired infections don't count as errors per se, but given they can be virtually eliminated with some thoughtful planning, they might as well be.
There's been some discussion about transferring some of the airline industry's best practices over to healthcare; however, that debate seems to have faded in recent years. But in light of the new HHS report, hospitals need to take a very hard look at their processes and cultures and make some tough choices. I'm suggesting a handful the entire sector should consider. Some are radical but others are just common sense:
1. Set legal liabilities for failing to report an error
The recent scandal at Pennsylvania State University was nauseating on many levels, but particularly because supposed role models turned their backs on horrific incidents of abuse. A patient who experiences an undisclosed medical error also is an abuse victim. Failure to report an error only makes it more likely to propagate even more of them. Hospitals should consider not reporting a garden-variety error a misdemeanor, depending on the circumstances. However, anyone failing to report a slip-up that leads to a patient death should face a felony prosecution--and potential loss of professional licensure.
2. Make RFID mandatory
Most retained instrument errors occur because the allied professionals screwed up their count or procedures for conducting a count. A radio frequency identification (RFID) system makes such errors far less likely. And if it make sense for WalMart to use RFID to keep tabs on taco shells, hospitals have no excuse. A separate monitoring system for smaller surgical components that can't carry an RFID tag should be mandatory as well.
3. Offer medical error insurance
Commercial aircraft passengers can usually purchase ample flight insurance at airports because the likelihood of a crash is virtually nonexistent. Patients should have the same opportunity to purchase such coverage before they check into a hospital. It won't be financially feasible to sell large amounts of coverage, but patients should at least be permitted to cover their health insurance co-payments and deductibles, as it's ludicrous for them to pay up when their care has been compromised. Pushback from insurers to keep their claims trends down--including subrogation suits against hospital liability policies--would eventually exert downward pressure on errors.
4. Require transparent complaint reporting
The number of passenger complaints lodged against airlines is reported monthly by the Department of Transportation as a matter of public record. Patients and their families should have a similar federally mandated and monitored system in place for gripes about healthcare delivery. Not only might these complaints shed light on medical errors that might otherwise go unreported, but also putting individual hospitals or providers in the sweatbox as the result of complaint clusters could improve their overall culture and performance.
5. Ban electronic devices for personal use
The New York Times recently reported about surgeons and other staff responding to emails and texts while making rounds and even during surgeries. We already know how dangerous it is to use mobile devices while driving; that it's occurring during far more complicated tasks is inexcusable. It's a simple policy change to ban the use of all electronic devices for personal use while on hospital property and not on a work break unless it's an emergency--and during procedures entirely. If patient care is an imperative, everything else is not.
6. Employ the unions
The unions representing nurses and other hospital workers regularly trumpet the role they play in promoting patient safety. However, that's mostly a negotiating tactic to preserve jobs and benefits and is actually of little concern to organized labor. It's time for hospitals to call unions on this bluff. Pegging portions of pay raises to error reduction and improved outcomes makes perfect sense, and given their past rhetoric, unions really can't object. This can be bargained for by empowering nurses and other allied professionals to better call doctors on their tendency not to wash hands between patients and other hubristic habits that degrade patient care.