What to Do About Poorly Performing Hospitals?

When I was in elementary school, I got good grades. Unfortunately, there was a section in my report card where teachers could make comments to my parents.

Mrs. Adler wrote something that, it turned out, was to be a repetitive theme: “Arlen is a bright student, but sometimes a behavior problem.”

Patients who go to a poorly performing hospital have a 50% higher chance of dying from a preventable error than those who choose one earning an “A” on the Leapfrog Group‘s newest safety report card. If all US hospitals would improve to the “A” level, 33,000 lives could be saved annually.

But, hospitals are not autonomous machines, although many patients think they are. Instead, they are a complex matrix of people who make mistakes for four basic reasons:

Cognition. Not knowing whether or how to do something, actually, is a small part of poor medical performance, based on malpractice case analysis. The metric is the standard of care, not the best care or the most high tech care, and it seems, most adhere to it.

Communications. Medical care is a series of hand offs, whether it be from the floor to the ICU, the ER to a follow up PCP, or a PCP referring to a specialist. Unfortunately, dropped hand-offs are rampant and account for a significant number of medical errors and eventual morbidity and mortality.

Documentation. Please, we've had enough complaining about the perils and pitfalls of EMRs and health information systems and how they can be dangerous to your health. Let's just fix it.

System errors. Systems are designed and incredibly efficient at getting the results they were designed to produce. Patients, doctors, and other sick-care workers are the victims. "The system made me do it" is a too convenient out.

Getting poorly performing hospitals to get better grades has to involve treating the disease and not the symptoms. The root cause resides in the people providing the care and the structure and processes they use to take care of patients. Medical care is a team sport. Relying on a franchise player to win championships often does not work. Medical professionals all mean well and unless we give them the education, tools, incentives, and metrics to improve, and hold them accountable for playing nice together, they too will be victims and fearful when they bring their report cards home to be signed.