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Death and Culture

July 11, 2008
by daphne
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Did you see the news the other day? The psych patient who died in a NYC ED after spending an hour in distress prone on the floor and ignored by staff? That hit home for me—I started my career in that hospital Network. I certainly wouldn’t presume to make a call, but a question keeps haunting me: We make such a big deal about IT solutions. Could IT have made a difference for that patient? Or is a hospital's culture the ultimate determinant of patient care?

It's always easy to cry outrage, but the headlines don't tell you everything here. Most people can’t even begin to imagine the real nitty gritty of the city’s public hospitals—how they have to accept every single homeless person, every single undocumented alien, every single uninsured person, the sickest of the sick. The sheer volume of humanity is almost unfathomable.

But here in NY anyway, our public hospitals have some pretty amazing IT. Lots of it is homegrown systems put together on a song and a prayer by some pretty smart folks. Smart…and dedicated. Folks who really believe that serving the underserved is the reason we get out of bed in the morning — and can look at ourselves in the mirror at night.

The dirty secret that isn't so secret, though? For many, it's a City job. The pension. The security. The "don't bother me, it's not my job" attitude. Did I mention the pension? My home town isn't alone on this — and that attitude isn't unique to the public sector, either. You may have seen it at your last hospital. Or maybe you saw it yesterday at the one you're at right now. Why are so many hospitals plagued with low adoption rates, workarounds that can kill — and indifference?

Me, I'm still wondering about that patient.

If a super-advanced EDIS and all the latest technology were in place in that emergency room, would it have made a difference? Or is culture, ultimately, the final call? If you know, or think you know, write me.

A bad attitude? The best IT in the world can't change that.

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Comments

Hi Joe and thanks for that link, interesting. It's cool to see some people in this setting actually making a concious effort to overcome that norm. Doctors, even!

My gut reaction to your post was "Francis Peabody's Caring for the Patient" quote:

"The secret of the care of the patient is in caring for the patient."

Caring, here, is meant in its most human sense.

There's a pretty good blog post elaborating here:
http://heroesnotzombies.wordpress.com/2008/02/20/if-you-care-you-try-you...

I dont think that pensions fundamentally set up a non-caring attitude. That said, you articulated a well recognized norm. It clearly does take leadership and energy to overcome the malaise of most budget-driven, organizational cultures. That's obviously real hard, as you point out.

daphne

Twitter @Daphne Lsawrence

Daphne Lawrence is senior associate editor at Healthcare Informatics magazine, covering the...