Extreme makeover: Hospital edition

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.

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.”

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