Wednesday, September 22, 2004

Ford on Patient Safety

The following is from Dan Ford. Some of you may remember a longer piece from him some months ago relating a personal story involving medical error.

I have frequent discussions regarding medical errors, physicians and leadership with executives in our industry. This includes many superb and well-qualified risk managers and others who are trying to do the right thing when unanticipated outcomes happen to patients. Their hands are too frequently tied in cultures with mixed messages, passive/resistant/non supportive CEO leadership, reticent physicians, traditional/historical staff behavior, the restrictive influence of insurance companies and legal counsel and the threat or reality of litigation.

As a search consultant, I have placed many hospital CEO's over the years, continue as a student of industry leadership and gotten inside the heads of many CEO candidates. I love this industry and am a strong industry supporter. There are many barriers, but there are CEO's willing to establish cultures of integrity and compassion in dealing with patient safety issues. My gut tells me we still have too many CEO's who are unable to establish true cultures of truth telling and accountability, genuinely believe they have such cultures, give lip service to such cultures, and/or may simply not understand that they are not personally heavily influencing positive human behavior inside their organizations --- even with a positive bottom line.

Some may have read the very thoughtful and pointed article by Nancy Berlinger in the Nov/Dec 2003 issue of the Hastings Center Report 33, no. 6, pp 28 - 36: "Avoiding Cheap Grace: Medical Harm, Patient Safety, and the Culture(s) of Forgiveness." She talks about 'avoiding the abuse of the unequal distribution of power between a physician and an injured patient, which may be further skewed by gender, race, income, age, culture, disability, or other factors. Relevant abuses of authority would include making a patient complicit in error by labeling her "non-compliant"; conflating error with "complications"; or taking advantage of a patient's religious beliefs --- "It was God's will" --- to conceal or minimize error.'

Having experienced this as a spouse, even as an industry insider, I can easily say that this behavior is very real. Unanticipated outcomes are going to happen, hopefully much less in the future with all of the positive changes taking place. Perhaps this playing field can be leveled with hospitals and physicians embracing accountability, telling the truth and doing the right thing.

This personal journey of mine, in giving patient safety presentations at the invitation of providers and serving on patient safety and quality committees has impacted my health care executive search practice. However, I am more than willing to continue to take this risk. Positive industry changes require people willing to stand up and constructively confront that which needs changing.

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