Health & Medicine - Posted by Amy Wolf-Vanderbilt on Wednesday, March 23, 2011 8:43 - 3 Comments 
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(1 votes, average: 5.00 out of 5) Loading ...Extreme makeover: Hospital edition
Unlike other environments, the doctor—not the manager—ultimately decides whether or not to try a technical innovation, often resulting in incomplete, ineffective and piecemeal implementation of otherwise promising technological processes. (Credit: iStockphoto)
VANDERBILT (US) — Medical errors—which are already at epidemic proportions at U.S. hospitals—will likely surge without dramatic organizational and cultural reforms within health care organizations, a new study suggests.
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The text of this article by Futurity is licensed under a Creative Commons Attribution-No Derivatives License.
The absence of a clear safety culture or an adequate conceptual toolkit for improving safety makes preventing medical errors difficult, according to the new study published in the New England Journal of Medicine.
“It’s shocking that as much goes right as it does in a hospital,” says Ranga Ramanujam, professor of management at Vanderbilt University.
“Reforms in the cost, access, and technology tied to health care are a step in the right direction, but they must be coupled with a clear strategy on how to change the culture of a health care organization or more medical errors are sure to happen,” says Timothy Vogus, assistant professor of management.
“In health care, a safety culture encompasses the shared values, attitudes and behavioral norms that every member of the organization needs to focus on to minimize patient harm,” Vogus says.
Directing attention to safety through personal example and organizational practices, so subordinates actually see certain actions that lead to a safer environment, accompanied by an atmosphere where practitioners feel safe to speak up and report medical errors without fear of recrimination, will allow health care leaders to enact safer practices on the front line.
“Enacting a safety culture relies on the willingness of frontline employees to communicate about potential sources of error and unsafe conditions, to disclose errors and near misses, and to transmit their concerns upward in the organization,” Vogus says.
Medical culture tends to focus on the autonomy of individual departments and practitioners, instead of the hospital or health care facility as a whole, making it nearly impossible to make across-the-board changes at hospitals nationwide.
The health care industry’s inability to embrace innovation prevents organizations from implementing key quality improvement measures, Ramanujam says.
“The professional culture of medicine contributes to the incomplete, ineffective, and piecemeal implementation of otherwise promising technological processes, such as electronic medical records or computerized physician order entry, resulting in a minimal impact on safety.”
Unlike other environments, in a health care setting the manager does not have final authority to implement a change—the doctor or other medical professional ultimately decides whether or not to try a technical innovation.
“Since a medical professional’s strongest belief is to help a patient, or at least ‘do no harm,’ they are often reluctant to try something new,” Ramanujam says. “Avoidance is a natural response when a behavior like innovation implementation threatens deeply held norms.
To improve implementation, hospitals need to practice several business strategies and practices, including:
- Develop leadership capabilities at all levels in the organization.
- Shift focus from individual to collective goals (e.g. focus on creating a culture of teamwork or safety.)
- Give individuals a voice in system development, maintenance and evaluation of new safety processes; share decision-making authority.
- Create opportunities for workers to experiment in non-threatening ways, such as training, pilot projects, dry runs and simulations for new clinical procedures.
“Taken together and in an integrated fashion, these strategies can serve as effective antidotes to the features that threaten advancement in health care today, and usher in an era that embraces innovation and results in better outcomes for patients and society,” says Ramanujam.
“Administrators should tailor each approach to their own organizations’ specific cultures and systems in order to realize their full benefits.”
More news from Vanderbilt University: www.vanderbilt.edu/news
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3 Comments
J Hayes
Craig Lindsay
Are there studies that compare different kinds of health care organizations, for example Mayo Clinic, Kaiser, or Group Health in Seattle vs. for profit hospitals, vs. non-profit? I don’t think Kaiser has hospitals but uses certain ones in its areas. Does Kaiser provide the kind of leadership looked for in the study? Or does it just rely on internal coordination and team work. (Full disclosure: I’ve been a patient of Kaiser’s for 30 years and have been impressed with their interdepartmental coordination, but I have never been hospitalized. Also I was a federal employee in an agency which promotes safety culture here and abroad for the industry it oversees.)
tamarque
In this climate of economic grab with consolidation of control at the top in the hands of fewer and fewer people, this proposal for more management at the top is very disconcerting. The idea of a team approach to health care is noted, but only as a passing concept. The primary one here is more top down management from authority that is further removed from the patient; ie, an insurance company model that
decides in cold, bottom line numbers what they will pay for regardless of the patient need.
The tendency in this culture is to commoditize everything including health care. The patient has no individual nuances. There are standard protocols that get applied with little variance. Chose 1 toxic drug or another, but a toxic drug it is.
What is never looked at is the system itself which does not work. We have no health care in this country. We have sick care, a system that thrives on creating sickness. Drugs are a major cause of illness but the system keeps pushing for more and more drug use. This despite the fact that 85% of all drugs have never been proven safe or effective for the purposes for which they are used. 85% of drugs have been shown to be worse than placebo, not tested for their uses, and/or put on the market with bogus study results (results that are manipulated either in the study itself or the analysis of the results).
85%!!!!! Is it any wonder that hospitals see unnecessary deaths to the tune of 250,000/year–a very And of course doctors are not required to report adverse reactions to drugs or mis diagnoses, etc. Actually, they dismiss patients reports of adverse reactions or act like that is okay so they just push another drug.
What is not looked at, as a profession, is the nature of disease and why a condition develops. The only interest is in finding a bug to blame or, today, a genetic defect to blame. The system itself is never to blame in this culture.
We do know that public health improvements have been the biggest reason for the demise of childhood illness. The CDC graphs show this very dramatically. Even the holy polio vaccine did not hit the market till the so-called epidemic was deeply on the wane. And since the polio vaccine, all diagnosed polio cases in this country have been from the vaccine itself. This is also true for the flu vaccine, particularly the nasal spray version. This, BTW is also true for dogs who become contagious after their vaccines.
Another things we know is that private control of the research with lucrative drug or devise patents being the goal has resulted in a major political and economic scramble. This situation has resulted in monitoring agencies being controlled by the very corporations that seek approvals. It has resulted in a revolving door between corporate boards and government agency boards. The head of the FDA was heavily invested in Monsanto. Such a relationship will never give us the real information on GMOs and the negative health impacts of such a product. In hospitals and other medical offices there will be no diagnoses related to these health impacts because the FDA has declared GMOs safe. It is the same type of manipulated process that declared agent orange not responsible for the severe illnesses of those exposed in Viet Nam. It is the same processes that refuse to look at the real research of vaccine dangers and the bogus claims for drugs that are never tested on people or looked at for long term damage or damage from the multiple vaccines pumped into tiny developing bodies of newborns.
The list for areas of defective safety practice is long in this medical industry. And an industry it is. Safety and patient cure or patient satisfaction is way at the bottom of the list. Patients are the pawns in the system. They need to be monitored and cultivated to be good, compliant patients. Articles are written on creating this compliancy. Actually, this is a fancy term for creating a co-dependent relationship with a cowed public that will open their mouths to take anything a doctor wants to throw in.
Actually one way to create safety is to have a patient population that pushes back and keeps the medical professions toes to the fire. These people need to be held accountable for what they do. The system itself needs redoing, not tweaking. Everything from the entire research process to the point of delivery needs a whole new model. Having a cold, objective chart in an office ordering services according to some formula has only sunk this country’s health to the bottom of an international comparative list created by a WHO study. We spend the most and get the least but the top of the heap rakes in billions in profits.
And we do have models to look at. Single payer health care does work, and works quite well as evidenced by Canada, for one very close example. Citing a long wait period was a temporary issue that got addressed years ago. The UK system also worked very well until recently when the reactionaries began to dismantle it. It was also a system that paid for holistic health and the cost saving numbers go along with the patient health improvement numbers for those holistic modalities. Prevention works–it just doesn’t sell expensive drugs. But safety issues are down. It is notable that whenever a system becomes more like that in the USA, the deaths from iatrogenic causes go up. That is a telling story.
Just goes to prove that our “for profit medical business” works just like other businesses! Profits are the goal, not service. No different than the management at the reactors in Japan.