Saturday, March 24, 2007

Sure but Slow

The venerated Massachusetts General Hospital (MGH) has long enjoyed the reputation of being the greatest hospital in the world.

How shocking, then, to read in last Saturday’s Boston Globe that it had been severely taken to task on quality issues by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), the chief national accrediting agency for health care institutions. The headline read “Surprise check faults MGH quality of care.”

Not so long ago, JCAHO began to conduct its inspections unannounced. Before that, they were scheduled, giving hospitals a chance to get ready. Also, JCAHO inspections now focus on actual patient care rather than on matters of structure and process, as was previously the case.

So when JCAHO popped in on MGH late last year, it came up with a lengthy list of “requirements for improvement.” The number was eventually whittled down to ten. If it had been 14, the hospital would have gotten “conditional accreditation;” i.e., something like probation.

The article didn’t list all of the infractions, but mentioned four - failure to wash hands between patients, failure to complete medical records, failure to record the extent to which pain relievers were relieving pain, and failure to find out what drugs patients were taking before being hospitalized.

The Globe followed up on the subsequent Tuesday with a rather rambling editorial. It lauded unannounced inspections and called for government mandated hospital “report cards.” It treated MGH gently, saying that the problems found “are easily corrected” – which they are not - and noting that “hospital caregivers do make mistakes” – ignoring the system failures which more likely are the cause.

Apparently, people do not yet want to accept how pervasive and deep-seated are the issues of quality and safety in health care, even in the most prestigious hospitals. But the truth will finally out, surely if slowly.

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