A recent study on medical errors committed in the US in 2008 showed that it cost $19.5 million, the loss of more than 2,500 potentially preventable deaths and more than 10 million lost days of work. The study, published in July 2010, put in stark perspective the tremendous cost that errors made by medical personnel can entail, despite attempts by health-related agencies to work towards zero-tolerance in the last decade or so.
Let me clarify that medical errors are best defined as a preventable adverse event of medical care that is the result of improper medical management, ie an error of commission, rather than the progression of medical illness due to lack of care, ie an error of omission.
Definitions aside, the cost of such errors are sometimes not measurable, such as pain & suffering and malpractice costs.
Given the above figures, one can imagine that medical errors can be somewhat frequent. Indeed, the Annals of Surgery reported that 9% of surgeons in the US admitted they had made a “major medical error” in the preceding three months.
So how do you avoid mistakes when going for surgery ?
Some pointers include looking for a hospital with a good safety record as well as those possessing a recognised accreditation standard (such hospitals voluntarily undergo screening by a recognised review body, such as the JCI, in order to provide services of a certain minimum quality).
Find out from your doctor where he sends his relative to. What’s good enough for a doctor is usually a stamp of approval. Why, even nurses in the hospital may provide the right doctor if one cares to ask.
Look for a doctor who’s busy. Sure, it means long waiting times, but this might be worth it in the long run.
Finally, some health department websites do provide statistics on how many specific operations are done in a year and what the complication rates are. This way one can opt for the best hospitals for a particular procedure.
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There are a lot of hospitals who claim to be among the world’s best – but has anyone ever listed what it takes to be one?
One good guide is the US News ranking based on set criteria, where it ranked the best 14 hospitals in the US:
List of US News’ Honor Roll Hospitals
1 Johns Hopkins Hospital, Baltimore
2 Mayo Clinic, Rochester, Minn.
3 Massachusetts General Hospital, Boston
4 Cleveland Clinic
5 Ronald Reagan UCLA Medical Center, Los Angeles
6 New York-Presbyterian University Hospital of Columbia and Cornell
7 University of California, San Francisco Medical Center
8 Barnes-Jewish Hospital/Washington University, St. Louis
9 Hospital of the University of Pennsylvania, Philadelphia
10 Duke University Medical Center, Durham, N.C.
11 Brigham and Women’s Hospital, Boston
12 University of Washington Medical Center, Seattle
13 UPMC-University of Pittsburgh Medical Center
14 University of Michigan Hospitals and Health Centers, Ann Arbor
The following eight factors were found to be common themes in explaining their success:
1. Innovation - A desire to practice in an environment that embraces evidence attracts nurses and other staff to these hospitals.
2. ‘Patient-first’ philosophy – a no-brainer really, but quite easily forgotten by hospitals who pay too much attention to the financial bottom-line. They often forget that its the patients (read ‘customers’) who are paying their salaries!
3. Collaboration – Teamwork creates better outcomes, and many of these hospitals have embraced fostering greater collaboration between disciplines. Every discipline brings a special domain of practice, knowledge and skill to create a village of information.
4. Quality Improvement- Structured processes for clinical services allow staff to define and sustain clinical practice standards and incorporate new findings into practice.Care processes and measures for success can be defined and measured via a balanced scorecard.
5. Quality Nursing Care – Patients come to the hospital expecting the best doctor and often, they will be given the treatment they need for their medical condition to improve. What makes the difference is the nursing. When nurses add on compasssion on top of the usual nursing skills, they give that extra edge.
6. Positive Work Environment – Nurses form a key component in any hospital, and to retain and attract them, the hospital management has to create an environment where people will want to work in. In my experience, a good pay is important but this is not the be all and end all. Other factors come into play like professional satisfaction and empowerment.
7. Continuing Education – one of the factors enhancing point 6. We are looking not at just professional education, but also at social skills like following up on complaints.
8. Staff Engagement – When you engage people closest to the work , you respect them.They want to know where the organization is going and what the driving value is, and you can demonstrate how their work contributes to that. That includes letting the staff know as and when new staff are brought in as part of succession planning.
In my years as a hospital manager, the above values keep on recurring time after time and quite often, many hospitals do not make it to the top quite simply because the above lessons are not assimilated.
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This one goes to, after much thought, the incident portrayed in the following video:
Its easy to see why this one gets the award when you take into consideration the following:
- The patient waited in the emergency room for 24 hours.
- She had collapsed for 1 hour before any action was taken.
- The utter indifference shown by other patients and staff.
- To cap it all, this did not occur in a third-world country!
Just for the record, the patient died of deep vein thrombosis. Read more in my earlier posting on the incident here.
Next Posting: Healthcare Blooper of the Year – Malaysian version
Judging from recent news reports, quite a number of US hospitals are resorting to deporting patients who have been stabilised but have nowhere to go. This applies particularly to illegal immigrants who are uninsured and unable to financially support themselves.
To highlight an example, the New York Times recently reported of a 35 year-old Guatemalan patient who came to the US illegally and was knocked down by a car 8 years ago in Florida. A community hospital saved his life, twice, and, after failing to find a rehabilitation center willing to accept an uninsured patient, kept him in the ward for years at a cost of US$1.5 million. During a prolonged legal battle, the hospital decided on its own to charter an air ambulance and fly the patient back to Guatemala, wheelchair and all, on the basis that this would be less expensive in the long run. Not so fortunate is, another patient, a 30 year old Mexican who is being deported by a hospital while in coma. Read about it here.
This case exposes a little-known but apparently widespread practice. Many American hospitals are taking it upon themselves to repatriate seriously injured or ill immigrants because they cannot find nursing homes willing to accept them without insurance. Medicaid covers emergency care (to some extent) but does not cover long-term care for illegal immigrants. However, hospitals are obligated by law to arrange for post-hospital care.
Still, human rights activists are understandably outraged -“there is something wrong with the system when the bottom line is more important than a human life”.
Hospital authorities counteract by saying – ” We are running a business. Someone has to pay for it at the end of the day. Besides, we have gone out of our way to send these patients back at our own expense. All of this is done legally – what about the felony charges against illegal aliens?”
My take on this is that the whole world is faced with limited resources especially in healthcare. Which is why in an earlier post (read here ), I predict that many countries will soon have to come to accept that :
..basic healthcare is a basic human right.
Many years ago, as a junior resident in a large overcrowded public hospital, I chanced upon an elderly man lying in bed looking very pale and ill and surrounded by two younger men looking at their friend(the patient) as if he was in death’s throes. As I breezed past on the way home after a rather tough stint, the younger man stopped me in my tracks and said if we could do something to help the elderly man as they had been told earlier by another doctor that the patient was terminally ill, nothing could be done and that the best thing would be to take him home to spend his last days comfortably in his own bed.
It was already late night but as there was a bit of extra time left before the call-duty was over, I took a brief look at his case-notes and summarised that the working diagnosis was that of advanced cancer of the lungs.
Having promised the patient’s friends that we would take a second look the next morning with the team, I headed off for home.
To cut a long story short, the diagnosis turned out to be a lung infection called aspergillosis and in next to no time, the patient was cured and able to walk home quite well.
I was constantly reminded of this gentleman as he would faithfully turn up once a year outside my office during the main festivity season bringing a celebratory gift. Although he did not speak English, the words, gestures and smile spoke volumes in terms of gratitude. These visits went on for several years till my staff took his visits almost for granted.
One fine day, we all realised that his visit had stopped coming for some time and it wasn’t till much later that word got to us that this fine old man had finally succumbed at home to what was presumably old-age.
This whole episode really got me thinking whether we as doctors do actually determine the fate of fellow human-beings. Much as the Hippocrates Oath or the Geneva Declaration on Health determine our behaviour towards patients, doctors are subjected to various constraints sometimes beyond their control. A missed diagnosis, inadequate review, insufficient resources are some of the factors which may hinder appropriate treatment and consequently lead to a different fate than what God probably intended…