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Wall Street Journal: “How to Stop Hospitals from Killing Us”

When there is a plane crash in the U.S., it makes headlines. There is a thorough federal investigation, and the tragedy often yields important lessons for the aviation industry. But as Dr. Makary, a surgeon at Johns Hopkins Hospital reports in the Wall Street Journal, the world of American medicine is far deadlier: Medical mistakes kill enough people each week to fill four jumbo jets. But these mistakes go largely unnoticed by the world at large, the medical community rarely learns from them, and patients are left in the dark about which hospitals have significantly better (or worse) safety records than their peers. Doctors swear to do no harm. But they soon absorb another unspoken rule while on the job: to overlook the mistakes of our colleagues. Roughly a quarter of all hospitalized patients will be harmed by a medical error. Medical errors are the sixth leading cause of death in America—just behind accidents and ahead of Alzheimer’s. The human toll aside, medical errors cost the U.S. health-care system tens of billions a year. Some 20% to 30% of all medications, tests and procedures are unnecessary, according to research done by medical specialists surveying their own fields. Hospitals as a whole tend to escape accountability, with excessive complication rates. Very few hospitals publish statistics on their performance. There is no reason for patients to remain in the dark; change can start with five relatively simple—but crucial—reforms. Online Dashboards: Every hospital should have an online informational “dashboard” that includes its rates for infection, readmission, surgical complications and “never event” errors (mistakes that should never occur, like leaving a surgical sponge inside a patient). It should also list the hospital’s annual volume for each type of surgery that it performs and patient satisfaction scores. Nothing makes hospitals shape up more quickly than this kind of public reporting. In 1989, the first year that New York’s hospitals were required to report heart-surgery death rates, hospitals with high mortality rates scrambled to improve; death rates declined by 83% in six years. Safety Culture Scores: If anyone knows whether a hospital is safe, it’s the people who work there. Dr. Makary and his colleagues at Johns Hopkins administered an anonymous survey of doctors, nurses, technicians and other employees at 60 U.S. hospitals. At one-third of them, most employees believed the teamwork was bad. At other hospitals, by contrast, an impressive 99% of the staff reported good teamwork. These results correlated strongly with infection rates and patient outcomes—good teamwork meant safer care. Cameras: According to Dr. Makary, doctors aren’t good at complying with well-established best practices in their fields. Cameras are already being used in health care, but usually no video is made. Reviewing tapes of cardiac catheterizations, arthroscopic surgery, and other procedures could be used for peer-based quality improvement. The notes in a patient’s chart are often short, and they can’t capture a procedure the way a video can. Open Notes: A process whereby a doctor dictates or reviews his or her notes with the patient at the end of a visit, in order for the patient to correctly corroborate on their own symptoms, and fill in additional details on an as-needed basis. No More Gagging: Increasingly, patients are being asked to sign a gag order, promising never to say anything negative about their physician. In addition, if you are the victim of a medical mistake, hospital lawyers will make never speaking publicly about your injury a condition of any settlement. To make transparency effective, government must play a role in making fair and accurate reports available to the public. When hospitals have to compete on measures of safety, all of them will improve how they serve their patients. If you or a member of your family has been injured as a result of medical malpractice, please contact us for a free appraisal.