Rosemary Gibson
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It's time for an answer: Is health care safer now?

11/30/2014

1 Comment

 
This blog cross-posted at Des Moines Register
This December marks the 15th anniversary of the landmark report from the National Academy of Sciences' Institute of Medicine that estimated up to 98,000 Americans die from preventable mistakes in hospitals every year.

It is time to know if health care is safer now.

Many hospitals in Iowa and elsewhere are working diligently to reduce medication errors, hospital-acquired infections and other causes of harm. Progress has been made, pockets of excellence created and people go home from the hospital alive and well.

A wake-up call in 2013 raised the stakes. The Journal of Patient Safety published new estimates that up to 440,000 lives may be lost annually in hospitals due to errors, making health care the third leading cause of preventable mortality in the United States. This number is equivalent to the combined populations of Des Moines, Cedar Rapids and Ames. Many more people are injured during their hospital stay.

Stresses and strains are making health care unsafe. Physicians, nurses, pharmacists and other health care professionals are forced to meet demands for higher productivity. They have to see more patients and do more, leaving little time to talk with patients and each other. Communication breakdowns ensue, and patients fall through the cracks.

The performance of any system with unsafe conditions that is forced to operate at a faster pace has only one way to go, and that's down.

On top of that, health care has become more complex with a steady stream of new equipment, devices, medications and electronic health records entering the sacred space of patient care.

Human ability to safely use this bounty is strained beyond capacity. Technology has become the new patient. Precious time is taken away from the real patient, the purpose of this whole enterprise.

The time has come to stop relying on estimates of health care harm. The public should know the unvarnished truth. Are we better off than we were 15 years ago? How many people go home alive and healthy when they may not have back then? How many do not because health care fell short?

The federal government counts the number of deaths from all causes, including cancer, heart disease, vehicular accidents and smoking — except medical harm. Counting the causes of mortality shows that society cares about every life cut short.

The numbers, and the human stories behind them, motivate people to act to reduce the burden caused when lives end too soon. Decades of sustained work to prevent and treat disease, design safer cars, and reduce smoking has extended life for countless numbers of people.

Objective progress is reported to the public that is deeply satisfying. The lesson is that when a problem is measured and reported, it is more likely to be fixed.

A public commitment to transparency and zero patient harm from hospital governing boards and senior leadership would strengthen the public's trust. The public will know that someone is in charge, is counting, and is accountable.

Right now, the public sees only a black box behind a wall of silence. Another 15 years will pass with the same result. We are obliged to do better.

Progress in reducing patient harm would give well-deserved attention to the highly skilled health care professionals who go to work every day to make health care better and safer for us all. That would be a good thing.

Rosemary Gibson is senior adviser to the Hastings Center and has authored four books, including "Wall of Silence," on health care issues. David P. Lind is founder of David P. Lind Benchmark, an employee benefits and health care research organization in Clive. Contact: david@dplindbenchmark.com.

1 Comment

Count the Dead From Medical Harm

10/8/2013

 
This blog cross-posted at Huffington Post

The military counts its dead and wounded even though politicians would prefer to hide the truth.

Public health officials count the deceased and injured from drunk driving. The alcohol industry might prefer to hide the mayhem by slashing public health funding, but wiser, compassionate minds prevail.

Counting the dead is a way that society says a life matters. It honors the deceased, a mother, father, sister or brother, son or daughter.

Failing to count them is to dishonor them.

In hospitals, nursing homes and other health care facilities, no one counts those who die or are injured because of preventable mistakes and infections.

In 1999, the Institute of Medicine of the National Academy of Sciences estimated 44,000 to 98,000 deaths from preventable health care harm. Courageous doctors and others took a stand. It was perhaps the first time in the history of medicine that the public was told the truth.

The 98,000 figure is more than the number of soldiers killed in the Korean and Vietnam war theaters combined, as reported in the Wall of Silence.

Still, the death toll has not compelled the government to routinely count mortality from iatrogenesis.

Parents fill the void. One of them is John James, Ph.D., a NASA toxicologist. His 19-year-old son, John Alexander James, died because of uninformed and careless medical care at a Texas hospital, according to a website Dr. James created in his son's memory. 

Dr. James conducted a study published this month in the Journal of Patient Safety in which he meticulously examines more recent studies. He estimates the number of premature deaths from preventable harm to be more than 400,000 Americans per year.

The jaw-dropping estimate means that a new Arlington National Cemetery is needed every nine months to bury the dead.

Why should the people of the United States rely on an extraordinary, dedicated private citizen to calculate estimates of a leading cause of morality in our country?

Powerful vested interests don't want we, the people, to know.

President John F. Kennedy warned the country about the dangers of secrecy in a 1961 speech, saying, "Secrecy is repugnant in a free and open society; and we are as a people inherently and historically opposed to (it) ... We decided long ago that the dangers of excessive and unwarranted concealment of pertinent facts far outweighed the dangers which are cited to justify it." 

Secrecy is unraveling the fabric of the health care system. The dishonor of the deceased is taking its toll. There is only one way out. Count the dead and the injured. Honor them as we would all wish to be honored.

    Rosemary Gibson

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