Three years ago, on a Friday afternoon, I received a frantic phone call from my mother. My active and healthy father was in the hospital with a suspected stroke. I immediately started driving to New Jersey, where they lived. I knew I had to be there to ensure that my dad would be safe. He had been taken to one of the most dangerous places in the world: a hospital.
The story of my dad’s three day stay in a major American teaching hospital is remarkably unremarkable.
On Saturday afternoon, he was given an infusion of a medicine intended for another patient — an infusion that was stopped only after I insisted that the nurse double-check the order. After she realized the error, she tried to reassure me by saying, “Don’t worry, this happens all the time.”
On Sunday, the neurologist ordered the wrong type of MRI, which yielded no useful information, left my dad’s diagnosis still in question, and cost American taxpayers thousands of dollars (my dad is on Medicare).
On Monday, he was discharged without the right prescriptions.
I am a practicing physician and spent most of the weekend by my father’s side, and even I couldn’t ensure that he received high-quality and safe care. The good news is that his “stroke” turned out not to be a stroke at all and after surviving his hospital stay, he has been able to manage his condition effectively.
When I tell this story, most of my colleagues shake their heads but they are rarely surprised. We have come to expect such failures as a routine part of health care. Yet the consequences are devastating. The Institute of Medicine estimates that as many as 100,000 Americans die each year in American hospitals due to medical errors. In 2011, a New England Journal of Medicine paper found that despite all the talk about improving safety, we have made little progress in reducing harm to patients. A recent federal report estimated that 27 percent of Medicare patients are harmed during hospitalization. That works out to a 5.2 percent chance of suffering an injury every day a Medicare patient is in the hospital.
The story of unsafe hospital care has no villains; the breakdown stems from the incredible complexity of the system. In 2013, a patient having a heart attack might spend five days in the hospital, including time in an emergency ward, cardiac catheterization lab, intensive care unit, and regular floor unit while receiving care from 20 to 30 nurses, a dozen or more physicians, and countless other providers. She would receive thousands of blood tests and dozens of doses of medications. The requirement for effective information flow due to hand offs is immense. And that’s just for a heart attack patient. Hospitals care for thousands of different conditions each year, each with its own challenges.
Complex health care delivery has been with us for decades, as has the evidence that we routinely harm patients. So why do we tolerate such a high defect rate in health care? Industries like aviation, auto manufacturing, and food handling have complex processes. Yet, these industries have figured out — for the most part — how to consistently perform safely. Providers and patients alike have given health care a pass. It’s different, we say.
When people die in a plane crash, it’s obvious why they died. When patients die in the hospital, it’s easy to blame their underlying disease. When auto manufacturers produce unreliable cars, the financial consequences can be devastating. Unsafe hospitals experience few financial consequences. When there is a salmonella outbreak because a food producer failed to use appropriate techniques, we hold them accountable. But when errors occur in hospitals, it is rare that anyone is held to account. The lack of transparency, financial consequence and accountability work together to ensure that when your loved one goes to the hospital, the likelihood that they will be harmed is unnecessarily high.
So what do we do? First, we need a systematic approach to tracking harm in the hospital. Doing so will let us know when patients are injured or even killed due to medical care, and help clinicians and health care leaders understand the magnitude of the problem in their institutions. Making this information public is even more important. Yet, this will not happen until patients and consumers demand it.
Second, hospitals need to feel the financial consequences of providing unsafe care. A large proportion of hospitals have not adopted cheap and easy interventions that substantially reduce harm. This is unacceptable. If we had a functioning market for health care, where patients got to choose with their feet and their wallets, unsafe hospitals would not survive. As the biggest payer of health care, Medicare is in a prime position to act, but has chosen not to. It’s time for policymakers to make a different choice.
Finally, we need to create accountability for patient safety. Senior health care leaders have to feel that their jobs depend on delivering safe care. Yet, most hospital boards never hold senior management accountable for safety. This is a choice that our health care leaders have made, and hospital boards can do better.
My dad’s experience in the hospital may have been common, but that certainly doesn’t mean it’s acceptable. Each of the key players in health care — consumers, payers, and providers — has a critical role to play in improving patient safety. We tolerate things in health care that we would never tolerate in other parts of our lives. It’s time we became a little less tolerant.