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In "How to Stop Hospitals From Killing Us" Surgeon Offers 5 Ways to Improve Health Care Safety


Posted by Brendan Faulkner of D'Amico & Pettinicchi, LLC on Sep 24, 2012 in Medical Malpractice

The Wall Street Journal published an essay Saturday by Dr. Makary, a surgeon at Johns Hopkins Hospital, "How to Stop Hospitals From Killing Us," in which he suggests 5 simple ways to improve health care safety.  

Dr. Makary points out that, although medical mistakes kill enough people each weekto fill four jumbo jets, they go unnoticed by the world at large, and the medical community rarely learns from them.  This is primarily the result of a cultural phenomenon that allows hospitals to escape accountability and to maintain an often-undeserved public trust. 

Dr. Makary posits that there is no reason for patients to remain in the dark like this, and suggests 5 crucial reforms:

1.  Online Informational Dashboards for all hospitals including their rates for infection, readmission, "never events," surgical complications, and their annual volume for each type of surgery performed.

2.  Safety Culture Scores.  Dr. Makary explains the correlation between good teamwork at hospitals (as reported by doctors, nurse, technicians and other employees in anonymous surveys) and safer care at those hospitals (as demonstrated by lower infection rates and better patient outcomes).  Good teamwork means safer care.  

3.  Cameras.  "It may come as a surprise to patients, but doctors aren't very good at complying with well-established best practices in their fields," Dr. Makary writes.  He cites a recent study in the New England Journal of Medicine which found that only half of all care follows evidence-based guidelines when applicable.  A technology that has been proven to improve compliance is cameras.  

4.  Open Notes.  Several hospitals, including Beth Israel Hospital in Boston and Geisinger Medical Center in Pennsylvania, have begun to use open notes. Through their health systems' secure websites, primary care doctors are inviting their patients to read the notes they write about them following visits, e-mail correspondence, or phone conversations.  Dr. Makary argues that patients are hungry for this type of transparency, and that it improves patient safety. 

5.  No More Gagging.  By the same token, more transparency is needed with respect to medical mistakes.  In a disturbing trend in the wrong direction, patients checking in to see doctors are being asked to sign gag orders, promising never to say anything negative about their physicians online or elsewhere. Similarly, medical malpractice settlements almost always include a condition barring the victim or his or her family from speaking publicly about what happened.  This type of secrecy runs counter to the strong public policy in favor of transparency.  As Dr. Makary puts it, "[t]o do no harm going forward, we must be able to learn from the harm we have already done."   

Dr. Makary is a developer of the surgical checklists adopted by the World Health Organization, and is the author of the recently published book, Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care.

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