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Hospital errors in your

June 4, 2009
by kate
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When it comes to transparency, some believe that what’s good for Minnesota hospitals is good for New Jersey hospitals.

According to the Gloucester County Times, there’s a bill in the N.J. Legislature would require hospitals in the state to post major medical errors online (Minnesota passed such a bill in 2003). The site would enable potential patients to compare data on different facilities regarding incidents of never events such as tools left inside patients after surgery and procedures performed on the wrong body part of person.

Yikes. I have to say that as a consumer — and one who was rather accident/injury prone in my younger days — it would be great to be able to quickly determine which hospitals have made the most errors, and avoid them if possible.

But as someone who reports on the healthcare IT industry and has been following the struggles of N.J. hospitals during the past eight or nine months, I have some doubts that this is the right approach. Like many other states, New Jersey has a number of organizations that are struggling to survive in these economic times — some of which have already had to shut their doors.

In 2008, 535 major medical errors occurred in New Jersey, resulting in 77 deaths. If every one of these infractions is published and out there to see, will that drive N.J. patients right out of the state to New York, Pennsylvania, Delaware or Connecticut hospitals?

As it stands now, N.J. hospitals are required to report never events, but it is done so confidentially according to the Patient Safety Act passed in 2005. The state releases reports about the number and types of infractions, but that information isn’t released right away, and is not categorized by hospital.

State officials say that this method allows hospitals to report the errors without risking serious damage to their reputation and lets them continue to focus on prevention. But those who support the legislation argue that it would force hospitals to improve performance and offer a higher quality of care.

It’s a tricky issue, and one that I think merits further discussion before anything happens.



Imagine two assembly lines, monitored by two foremen.

Foreman 1 walks the line, watching carefully. "I can see you all," he warns. "I have the means to measure your work, and I will do so. I will find those among you who are unprepared or unwilling to do your jobs, and when I do there will be consequences. There are many workers available for these jobs, and you can be replaced".

Foreman 2 walks a different line, and he too watches. "I am here to help you if I can," he says. "We are in this together for the long haul. You and I have a common interest in a job well done. I know that most of you are trying very hard, but sometimes things can go wrong. My job is to notice opportunities for improvement skills that could be shared, lessons from the past, or experiments to try together and to give you the means to do your work even better than you do now. I want to help the average ones among you, not just the exceptional few at either end of the spectrum of competence".

Which line works better? Which is more likely to do the job well in the long run? Where would you rather work?  [Where would you rather go for care?]

In modern American health care, there are two approaches to the problem of improving quality, two theories of quality that describe the climate in which care is delivered. One will serve us well; the other probably will not.

-- from:
Sounding Board: Continuous Improvement As An Ideal In Health Care.
The New England Journal of Medicine.
Donald M Berwick, MD, MPP
January 5, 1989. 320 (1). pp 53-56.

Thanks for your post, Kate.  You're obviously very sensitive to the perils, both of efforts to inspect in quality (doesn't work by itself), as well as non-transparency and it's laissez faire consequences.

The second foreman is taking the view the the process is the most important issue;
the first foreman is playing the shame and blame game.  This always drives fear into the system and improvement is generally not possible:

The notion that quality is a system property may be a bit
counter cultural, but it is not hard to grasp. It is obvious that
any specific automobile has a certain top speed. That top
speed characterises the automobile. A person displeased with
his/her car's top speed is fully entitled to get angry at the car,
to give it incentives to go faster, or to put an incident report in
the car's file. But none of this, of course, will matter the car
will still never go faster than it is inherently able to. A driver
who wants to go faster is going to need a different car. So it is
with variations in the quality and results of care.

I would definitely prefer to get my care from a system managed by a type II foreman.

Thanks to both of you for your comments. It's a very tricky issue and one where I don't think we can be too hasty in making a judgement.
Daphne - I wish I could say I disagree about shady NJ politics, but I'd be a fool to say so. Still, there are many great things about the Garden State!
Joe - I really like the point about the two approaches. I know which foreman I'd rather work for (number 2), but I'm still not sure where I'd rather go for care.
It's a compelling issue.

Kate, that's one of the reasons I never moved to Jersey (for a while I was considering it.) "Seriously damage their reputations" my eye. Boo hoo. That's NJ doubletalk for "let's continue our long history of as little transparency as possible." As for the fact that many hospitals in NJ are currently facing bankruptcy, there is something a CIO said to me last week that makes a lot of sense here: "Hospitals do a lot of things they can't afford if they're mission ciritical."