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What hospitals can learn from Southwest Airlines

Consumer Reports News: April 12, 2011 08:08 AM

When Southwest Airlines recently learned that some of its planes had small cracks that could lead to gaping holes in mid-flight, it grounded the planes and ordered an independent safety review. Not perfect, maybe, but at least fast and transparent. In fact, over the past few decades the airline industry has developed a pretty good reputation for safety. I wish the same could be said for our hospitals.

Unfortunately, a recent report in the journal Health Affairs suggests that there are lots of cracks even in good hospitals that can lead to gaping and potentially deadly holes in patient care. And unlike the airline industry, the study suggests that safeguards to detect and correct the cracks are inadequate.

The study, by a team of researchers who have spent their careers trying to improve hospitals, shows that a rigorous approach to reviewing hospital care finds ten times the error rates and safety problems compared with current reporting systems. Records of almost 800 patients were reviewed from three unnamed hospitals that have made significant efforts to improve care and reduce errors.

It doesn’t take a genius to figure out at least part of the problem. The current systems rely either on doctors, nurses, and other staff to voluntarily report errors, or on information obtained from administrative reports used primarily for insurance billing purposes. Now, few health-care folks are likely to admit that the “crash” that occurred in the ICU involving your mother was their fault. And using billing records to detect hospital errors is, at best, a roundabout way of detecting hospital errors.

Fortunately we know that when hospitals do measure their errors—for example hospital-acquired infections —and they confront their staff with those errors, the hospital “culture” can be changed and errors can be reduced, sometimes dramatically.

But many hospitals refuse to measure infection rates, refuse to confront their staff, and continue to impose significant and silent suffering on their patients. And because public and private payers have signed on to this conspiracy of silence, it’s often hard to know whether your hospital has or hasn’t found the cracks in their care and taken steps to fix them.

There is some good news. The new error-detection tool used in the current study was developed by the Institute for Healthcare Improvement—a private independent organization founded by Don Berwick M.D., who is now the Administrator of the federal agency that oversees Medicare and Medicaid. Berwick has made safety his number one priority. And this study could help him get the attention of hospitals, doctors, and nurses to institute more rigorous, systematic tools—similar to the airline industry—to detect mistakes, correct them, and end needless suffering.

After all, no one wants to be in an airplane—or a hospital—with a hole in the roof.

See our hospital Ratings, which compares hospitals in your area based on bloodstream infections, patient experiences, and more.

‘Global Trigger Tool’ Shows That Adverse Events In Hospitals May Be Ten Times Greater Than Previously Measured [Health Affairs]

The Institute for Health Care Improvement

John Santa M.D.

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