Tuesday, March 13, 2007

Encouraging News

Occasionally, landmark developments pass by unnoticed.

One such may have been reported last week. The March 5, 2007 issue of The Boston Globe carried an article by Christopher Rowland, veteran medical reporter, about the increasing attention hospital trustees are giving to patient safety; i.e., “preventing errors that lead to patient injuries and deaths.”

It has long been a firm tenet of the culture of health care that matters relating to the practice of medicine and surgery were to be dealt with by the medical staff and not to be “interfered in” by managers or trustees. This same tenet is behind the statement, popular among politicians, that “medical decisions ought to be in the hands of doctors and patients.”

Those who pay attention to such things remember the Institute of Medicine report of 1999 which stunned the world of health care by reporting that as many as 90,000+ Americans were being killed each year by medical errors. As became clear both in the report and in subsequent discussion, many if not most of these errors could be traced not to unavoidable accidents or careless individuals but to flawed systems. An example would be the prescription of a drug by one doctor who did not know that the patient was on an incompatible drug that had been prescribed by another – or a patient given the wrong drug or dosage because the prescription was misread.

These system issues are not confined to either the professional or institutional components of health care; i.e., doctors or hospitals, and so remedies have to deal with both.

Correcting flawed systems is not something that doctors are organized to do, and so hospitals have to do it. But the traditional and deeply entrenched separation of institutional and professional roles in the culture of health care has made them reluctant to take on that responsibility. Progress in responding to the Institute of Medicine report has been slow accordingly.

Rowland’s report suggests that hospital trustees are beginning to recognize and accept the necessary role of hospitals in guaranteeing patient safety. That is encouraging news.

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