The real story will likely be more complicated. It will involve the difficult choices that have to be made by hospitals regarding how to allocate scarce resources in the operating and capital budgets. It will involve the matrix used in these decisions, weighing the need for upgrades of clinical equipment and that of infrastructure. Or, of adding staff on the clinical floors versus staff in the infrastructure areas. The problem will reside in the priorities established by the administration and the hospital's board of trustees. It will have been aggravated by insufficient state funding for Medicaid patients and concerns about future federal cuts in Medicare.
And, it will not be that the administrative and board judgments were necessarily wrong or suffered from a lack of rigorous analysis. It will just be that they turned out to be unlucky. There but for the grace of God goes almost any hospital in the country, starved for resources to maintain basic infrastructure.
That, though, won't be in the newspaper story. The personal tragedy of the guy who falls on his sword will result from the hospital's need to blame somebody to expiate its perceived sin in the public arena.
And I wonder, what would happen if the truth were simply presented? Wouldn't that be, and point, the way toward a future worth striving for?
ReplyDeleteYes exactly, Bart, as it would be in the case of clinical errors as well. Assigning blame often means that systemic problems never get addressed.
ReplyDeleteit appears they were not the only ones, which may diffuse the impulse to blame. But, clearly the issue needs to be rethought, along with many others:
ReplyDeletehttp://www.cnn.com/2012/10/31/health/new-york-bellevue-evacuation/index.html
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ReplyDeleteAsking honestly where the problem may stem from leads to the lasting solution. Getting into dialogue (even though it can be difficult especially in the early phase of the process) pays off!
Your description of the process of pushing the blame down the line is right on. I have lost many managers and friends to the attrition of "finding someone to take one for the Gipper" rather than serious effort to solve or even recognize the problem.
ReplyDeleteHaving worked in the hospital and participated in disaster drills, I think that commendation is due to the staff efforts required to evacuate the patients. The public may never appreciate the efforts it will take on both the sending and receiving staff.
As to why the generators failed, firing someone won't answer the question, will probably leave a valuable knowledge gap where the "fallen soldier" was standing. It will leave a staff that was struggling through a disaster, now to face a makeover of their management structure. The "white knight" coming in will probably serve more to disrupt the process than solve the problems. The newcomer will know that his head is on the block so the outcome will be everyone playing defense and the next disaster will come along and there will be more head scratching about why this or that failed.
Oh...brings me back to two directives - one, replace every hospital bed. Two, replace the ED ceiling. Only money for one. We chose beds. The ED ceiling collapsed during a break in a water main caused by a storm. Evacuation of patients; redirects for rescues. We all felt the full wait of that no-win choice.
ReplyDeleteIs there an example of a situation like this which is described carefully and clearly to the public, where the public is educated that it isn't as simple as "they should have done this, they didn't, it was the personal fault of an individual" but rather, "they faced multiple choices and insufficient resources to tackle every problem, and this happens every day in administration as well as clinical work. Outcomes are not certain, and we are always forced to take risk. What can we learn from the situation to apply to analogous situations taking place around us right now?" I am frankly a little cynical that that a story of this magnitude can be articulated clearly to the public and appropriate learning and action can take place. Again, I mean on the public level, not within the institution, where I would hope it is more likely to be addressed objectively.
ReplyDeletePaul you might be surprised to learn how many facility engineers are failing to follow NFPA 90 with re: to emergency generator routine checking operations. On a monthly check they are to be started by activating the automatic transfer switches (ASO) to see if they in fact will start the generator (s). Rotating to each ASOs in a facility (many hospitals have a dozen or more depending upon its size ) each month is the way to check them all each year. Sometimes all that is done is to start the generators manually but this precludes you knowing whether or not the ASOs work or worse they may not be connected to the generators. I’m glad you highlighted this topic because CEOs and COOs need to go into the facilities engineering areas as a student and learn something about them…you probably surmised that I have been a recent student on this subject.
ReplyDeleteI wonder if this hospital is subject to JCAHO inspections. I would be curious to find-out what the inspectors found.
ReplyDelete