tag:blogger.com,1999:blog-32053362.post116125206724868121..comments2024-03-29T06:37:18.029-04:00Comments on Not Running a Hospital: Errors, Improvement, and DisciplinePaul Levyhttp://www.blogger.com/profile/17065446378970179507noreply@blogger.comBlogger9125tag:blogger.com,1999:blog-32053362.post-22188356453400429912007-08-20T18:25:00.000-04:002007-08-20T18:25:00.000-04:00Paul - thanks for pointing me to this. I've criti...Paul - thanks for pointing me to this. I've criticized you and pushed on quality related items, but I'm very glad to hear about the committment to safety and integrity in this example you shared.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1162071259397955722006-10-28T17:34:00.000-04:002006-10-28T17:34:00.000-04:00Thanks. This is actually very hard to do well, an...Thanks. This is actually very hard to do well, and as I have noted, some aspects should remain confidential to ensure that a robust peer review process takes place. There is a wide range of opinion, beyond that, as to what should be public and what should not. I will return to this topic again when I post a section on apologies.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1161380736026747032006-10-20T17:45:00.000-04:002006-10-20T17:45:00.000-04:00I felt the same way, Dave, and you can imagine how...I felt the same way, Dave, and you can imagine how I felt when the email arrived, just hours after i had sent out mine. Think about a young man or woman, say 24 or 25 years old, treating a wide variety of patients, and having the presence to reach the conclusions s/he did. It was one of the best things that I have experienced in the last 4 1/2 years.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1161310485645796272006-10-19T22:14:00.000-04:002006-10-19T22:14:00.000-04:00Thanks, but I think our process is similar to most...Thanks, but I think our process is similar to most hospitals, at least here in Massachusetts. We have made no attempt to measure the effect of all this on malpractice cases or insurance costs. It is really designed mainly to improve patient quality and safety, in their own right. If there is some benefit in the malpractice arena, that is just icing on the cake.<BR/><BR/>We do have a strong risk management program, however, as part of our ownership and membership in CRICO, the captive insurance company that serves the Harvard hospitals, and the Risk Management Foundation, which provides excellent training to doctors, nurses, and others in the Harvard system.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1161304508621972502006-10-19T20:35:00.000-04:002006-10-19T20:35:00.000-04:00Your policy and process sounds exemplary. I wonde...Your policy and process sounds exemplary. I wonder how long has it been in place and what effect, if any, has it had on malpractice litigation, the cost of settlements, and the hospital's cost for malpractice insurance?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1161287911226732342006-10-19T15:58:00.000-04:002006-10-19T15:58:00.000-04:00There are certain parts of the review of medical c...There are certain parts of the review of medical cases that are assisted by the confidentiality of peer review. For one thing, it makes it more likely that a doctor or nurse will admit that he or she made a mistake. It is also makes it more likely that their peers will comment on the case with the unvarnished truth. This process results in both personal and systematic improvement in a medical center. That is why some parts of the medical improvement process are held in confidence.<BR/><BR/>But, there are certain things that are made public. For example, a disciplinary action of the sort described here is made public. Also, as noted in other parts of this blog, there is good reason to publish a doctor's or a hospital's clinical results, i.e, mortality and morbidity figures for the various types of medical procedures and treatments. That data does not accuse a doctor of anything. It just lets the public know how well he or she does in taking care of patients. <BR/><BR/>So, I guess what I am saying is that there are different kinds of accountability. Sometimes confidentiality is more effective in the long run. Sometimes public exposure of an individual's actions is more effective. Sometimes public disclosure of data is more effective.<BR/><BR/>Our job as a society is to decide which forms of accountability are most useful and appropriate. We do not want to be unduly punitive and adopt strategies that will cause uninetneded consequences -- but we also don't want to hold back when public exposure is the right remedy.<BR/><BR/>I'll have more on the apology issue in a future posting.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1161284077159172102006-10-19T14:54:00.000-04:002006-10-19T14:54:00.000-04:00As a reporter, I can't say that I enjoy publicizin...As a reporter, I can't say that I enjoy publicizing people's errors.<BR/><BR/>But it's part of being accountable. Corporate honchos, police officers, air traffic controllers and the like are routinely and publicly held to account when something doesn't go as planned. <BR/><BR/>When I make a mistake, it's right there on the front page for everyone to see. Any reader is free to write a letter to the editor that criticizes my work or criticizes the newspaper's judgment, and more than likely that letter will be published.<BR/><BR/>I don't mind being held to a standard. It keeps me and my colleagues on our toes. Physicians should not mind being held to a public standard either. From personal experience, I can tell you: Nothing good ever comes from shrouding the bad in secrecy and equivocation.Pieces of Mindhttps://www.blogger.com/profile/14622621519712148952noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1161274550518311182006-10-19T12:15:00.000-04:002006-10-19T12:15:00.000-04:00I am curious about what this physician did, but I ...I am curious about what this physician did, but I guess that isn't going to be revealed. I have had occasion to contact the hospital ombudsman several times and have basically been blown off. They say the doctor will be contacted, but that they are not allowed to tell me how the matter was resolved. This is frustrating to patients. They even passed a law here in AZ that says doctors can apologize to patients without the apology being used against them in a lawsuit. But they still don't--or won't. <BR/><BR/>Star<BR/>http://healthsass.blogspot.com<BR/>I blogged this siteStar Lawrencehttps://www.blogger.com/profile/04130255761118933523noreply@blogger.comtag:blogger.com,1999:blog-32053362.post-1161259060596963602006-10-19T07:57:00.000-04:002006-10-19T07:57:00.000-04:00I know this case and two things were especially tr...I know this case and two things were especially true: the doctor really is fabulous AND the hospital did the right thing. The nurse's story proves that, I think,Anonymousnoreply@blogger.com