Sunday, July 20, 2008

Levi’s Gone About As Fer As He Can Go

A couple of weeks ago, a surgeon at the Harvard-affiliated Beth Israel Deaconess Medical Center (BIDMC) operated on the wrong side of a patient.

A few days later, Dr. Kenneth Sands, Senior VP, Health Care Quality, and Paul Levy, CEO, issued an e-mail to all BIDMC staff reporting the incident. The e-mail and related postings can be seen in Levy’s blog at www.runningahospital.blogspot.com. The e-mail includes a link to the story of the event as it appeared in the Boston Globe.

Not so many years ago, a hospital would have kept such an incident as quiet as it could. No more. Paul Levy, to his eternal credit, faced the issue publicly and directly.

But he did not go far enough for some. In his own blog (www.the-hospitalist.org/blogs) Dr. Bob Wachter, a health care quality guru at UCSF said that when Levy prefaced his e-mail remarks by noting that the surgery occurred on “a hectic day,” he overlooked the fact that most days in surgical suites are hectic, due to the continuous pressure to maximize productivity, with lower priority being given to safety. Wachter suggested that as part of the corrective action being taken, Levy needs to address this cultural issue.

Wachter’s second point related to the recommended safety protocol in surgery which includes a “time-out” in advance of each case, at which time each member of the surgical team agrees that the right surgery is about to be performed on the correct side of the right patient. According to the Sands-Levy e-mail, this did not happen in the case being reported. In his posting, Wachter expressed some skepticism that this was an oversight on the part of every member of the team, implying that the surgeon may well have been one of those who did not comply with this standard. He suggested that if this were the case, disciplinary action should have been taken against the offending surgeon.

Wachter has a point, but it also deserves to be mentioned that in doing what he did, Levy was already pushing the edge of acceptable executive behavior in hospitals. According to the e-mail, he got the BIDMC medical chiefs to approve his taking the matter public. Had he also gone for disciplinary action, he might well have lost their support. And had he lost the support of the chiefs, he almost certainly would have lost the support of his trustees.

Paraphrasing the words of Kansas Citians in the musical Oklahoma, I suspect he’s gone about as fer as he can go.

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