The Globe yesterday ran a story on hospital-acquired infections, noting that the Commonwealth of Massachusetts might require hospitals to report their statistics on this matter. This is a good thing, part of a trend slowly spreading across the country.
It is good for two reasons. First, the public has a right to know about fundamental measures of patient quality and safety in institutions in their communities. Second, as a management tool, there is nothing more effective for hospital administrators than to be able to remind their staffs that actual clinical results will be made public.
But, here is the subtle and very important point. If public reporting devolves into a culture of blame, it will undo all the good that would otherwise be done. Here, reporters and politicians need to be very careful.
The idea is to use data to bring about constructive change and improvement. While some hospital-related infections, injuries, and death are the result of a doctor's mistake, many are the result of systemic problems that take analysis, understanding, and thoughtful problem-solving to fix.
I can also assure you that, when a doctor makes a mistake, he or she already feels more remorse about it than you can imagine. There is no reason to pounce on people who have devoted their lives to helping us.
I believe that many doctors and hospitals do not want to post these data because they have little confidence in the ability and motivation of the press and elected politicians. They fear they will just be punching bags or targets for commercial or political gain.
So, yes, hospitals and doctors face a challenge in overcoming their defensiveness and reluctance to share in this arena -- but the rest of society faces an equally difficult challenge in using the information responsibly.
I have chosen to post BIDMC's data because I believe the only way for us all to learn how to do this well is to actually do it. I continue to hope that my colleagues in the Boston area hospitals will join in and that our journalists and elected officials will provide the kind of positive reinforcement that makes this truly infectious behavior.
Mr. Levy,
ReplyDeleteYour comments are right on the money. Mandatory reporting of infection rates is a partnership among healthcare providers, consumers and politicians.
Too many times we try to boil-down issues to 'good/bad, black/white' outcome. As someone involved in infection prevention I see the issue as multifaceted. Reducing infections eventually involves finding the source. Such detective work requires participation of many disciplines within a hospital including epidemiologists, administrators, IC professionals, facility engineers and front line care providers.
I've discussed mandatory reporting with clients and others in NY, PA, OH and Massachusetts. The common thread I see is that the early adopters, such as your hospital, are doing well. Those that embrace reporting and participate in shaping the conversation improve their care. Your leadership in this issue will come with risk, but reaps rewards in the long run.
Finally, I hope that the politicians and lobbyists look at the lessons learned in PA. They've refined their system and have a high percentage of reporting participation. Perhaps this could lead to a better, fairer system.
Joel A. Dombrowski
I also agree that these stats need to be posted for the public. But your point about it becoming a blame game is true. I'm not sure if the public on a whole is going to be able to refrain from, "Oh, I went to that hospital with the high infection rates/patient injuries/etc and they were awful! Listen to what they did to me..." Which of course some of these individual stories will be in the media. This will lead to a negative spirally effect. It could potentially be the downfall of some hospitals that are trying to put forth strong efforts in improvement.
ReplyDeleteMany nosocomial infections result from a lack of RN care hours per pt. The nurse in me hopes this avenue will be looked at and hospitals will increase their RN staffing.
This is right on:
ReplyDeleteThe idea is to use data to bring about constructive change and improvement. While some hospital-related infections, injuries, and death are the result of a doctor's mistake, many are the result of systemic problems that take analysis, understanding, and thoughtful problem-solving to fix.
We see examples in the press and on TV of the emphasis on blaming someone all the time instead of figuring out how to change the system to avoid such problems the next time. Good product producing companies use data about their failures in the fashion to improve their quality.