A group of physicians and professors ruminate on hospital innovations, best practices
Orange County, CA - August 9th 2016 - Last May, Dr. Martin Makary and colleagues penned an open letter to the Centers for Disease Control and Prevention requesting that medical error be appropriately listed as the third leading cause of death in America, in place of respiratory disease. The authors argue these deaths are perpetuated by the CDC’s lack of acknowledgment, as national health priorities and funding for research are proportionally tied to the impact an issue has on society.
The leading causes of death in America are heart disease, responsible for 611,105 deaths annually and cancer, which claims 584,881 lives annually. By accounting for medical errors, the number of yearly preventable deaths would decrease by 40 percent, pertaining to 149,205 (respiratory disease) instead of 251,454 (medical error) deaths a year.
Makary says death certificates are limited to a specific set of causal factors. For instance, if medical error is listed as the reason for death, only the underlying condition—such as cancer or heart disease—is counted in mortality statistics, even if said condition proves to be nonfatal. The CDC’s documentation system abides by International Death Certificate standards, allowing rate comparison amongst other countries.
Reform of death certificates through recognition of reasons for preventable harm such as lapses in communication or incorrect medicine dosage can provide accurate data for further research and remediation. This issue was brought to light by a 1999 seminal work by the Institute of Medicine called To Err Is Human: Building a Safer Health System. The work highlights an assortment of medical errors and proposes courses of action specific to each issue. According to a recent study, the paper has led to three waves of healthcare innovations: technical advancements, standardizing procedures, and high reliability organizing.
The initial chapter was marked by technical advancements to surgical procedures through improved instruments and refined training approaches, making surgeons better equipped to avoid preventable harm. Systems like the da Vinci from Intuitive Surgical facilitate robot-assisted minimally invasive surgeries, lowering the risk of infection and reducing recovery time. 3D imaging and high definition cameras are just some innovations with the propensity to foster patient safety. With technical and technological aid, surgical students can experience procedures while maintaining extreme attention to detail. Although improvements have emerged from this stage, the authors state the industry has hit a plateau in patient safety.
During the second wave, hospitals implemented structural changes in administering standardized key processes through mechanisms such as checklists and protocols. From proper insertion of a Foley catheter to questions to ask when admitting patients, all daily tasks were standardized to prevent deaths due to ineptitude. Methods for compliance measurement, like performance reviews and quality checks, were adopted in hopes that consistency would translate to increased patient safety.
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Although enacting standard procedures works consistently in settings such as manufacturing, the complexity and case-by-case nature of patient care has pushed the medical community to the apex of diminishing returns with process compliance, checklists, and quality measurement,” wrote the authors. Currently, the medical industry is in the midst of the third wave - high reliability organizing. In this phase, attention to communication among individuals and work flow efficiencies supplant a necessity for standardization and technical advancement. For optimized patient outcomes, the authors suggest embracing difference and developing practices that allow physicians and nurses to adapt to nonconventional occurrences. Cultivating this kind of culture make medical teams better equipped to intervene when unintended errors occur and inclined to discuss a mistake, in the case of one. The authors stipulate that the latest stage “
will require a stronger focus on how people, process, and practice come together in patient care, rather than solely on technical or structural innovations.”
Although enacting standard procedures works consistently in settings such as manufacturing, the complexity and case-by-case nature of patient care has pushed the medical community to the apex of diminishing returns with process compliance, checklists, and quality measurement,” wrote the authors. Currently, the medical industry is in the midst of the third wave - high reliability organizing. In this phase, attention to communication among individuals and work flow efficiencies supplant a necessity for standardization and technical advancement. For optimized patient outcomes, the authors suggest embracing difference and developing practices that allow physicians and nurses to adapt to nonconventional occurrences. Cultivating this kind of culture make medical teams better equipped to intervene when unintended errors occur and inclined to discuss a mistake, in the case of one. The authors stipulate that the latest stage “
will require a stronger focus on how people, process, and practice come together in patient care, rather than solely on technical or structural innovations.”
