Wednesday, December 03, 2014

People deserve better

After reading my post below about the slow pace of quality and safety improvement in my home state, a reader wrote an in-depth summary of her mother's experience at one of the Harvard teaching hospitals. The care was replete with medical errors, failure to disclose, and unhelpful attitudes.  (The reader is an RN, who then went on for additional education and received an MBA, returning to work in the medical world on quality improvement.)  Here's a portion of the note:

It was a nightmare.

They sent me a bill for hundreds of thousands of dollars.  I wrote back, enclosing the daily notes that I had kept since the beginning, and told them that since the costs were due to their mistakes, I would not be paying them.  In my letter, I offered to work with them to use this case as a teaching tool for their residents.  I actually was so naive that I thought they would jump at the offer--surely the great teaching institution had a rigorous continuous quality improvement program, right?

After several months, I received a letter to the effect that in their munificence, they would waive the charges.  No mention of my offer. The medical records that I received per request, independent of the letter, had only the most superficial documentation of her stays there--no nurse's or doctor's notes.

I can only imagine the rococo channels that my letter and her case traveled throughout the hospital before their determination.

I wish this were the only example I have received, but it is not.  There is an overwhelming degree of arrogance in many of these institutions.  They believe their own propaganda about being the best in the world.  Some of the individual doctors might be the best in the world in particular subspecialties, but the care delivery systems are not.  The people of this region deserve better.


nonlocal MD said...

Community hospitals where I worked for 21 years are just bad, but academic medical centers are bad AND arrogant. What a combination.

Jeff T said...


We eventually will reach a tipping point where the arrogance will have to be replaced with humility. Healthcare institutions and providers have good intentions to provide safe care but the cultural barriers and lack of leadership prevent making identifying and implementing improvements.

I too had a close family member who was hurt by severe complications that were failed to be recognized following surgery. This led to many months in the hospital. Although the institution failed to recognize the delivery brekdown, I believe that efforts were done to prevent future breakdowns. Pleae note that I worked at this institution in qualtiy improvement and was able to evaluate improvement efforts.

There are institions who are making a difference and improving quality. I have hope for the future, and I think the arrogant institutions that do proivde high quality will not survive in the long term.