The Great ‘Quality Escape.' Not Just For Boeing, Healthcare Does It Too

Is Healthcare Safer Than Flying?

Given the well-publicized quality and safety failures going on at Boeing, it’s a fair question to ask about the American Healthcare Industry.

Healthcare’s thinking and management around safety and ‘zero harm’ has been wholly fashioned after the airline safety methods—it used to be the leading standard for any industry.

If you ask any hospital leader from the last twenty years, they will say that the airline’s philosophy regarding ‘safety’ and ‘high reliability’ culture are the best tenants to follow: preoccupation with failure, deference to expertise even if that individual is in a ‘lower rank,’ appreciating that the work is complex and cannot be simplified. And certainly, everyone in an organization knows that ‘cutting corners’ to improve efficiency is an equation that leads towards errors, mistakes and miscommunication.

Yet, Boeing claims that their many fatal errors and mistakes are ‘quality escapes’ from manufacturing.

What the Heck is a ‘Quality Escape,’ or ‘Medical Misadventure?’

In healthcare we don’t call mistakes and errors ‘quality escapes,’ but many people do call them ‘medical misadventures,’ ‘unintended consequences,’ or simply feel that poor patient care and bad outcomes are just an expected part of ‘healthcare’s journey towards safety.’

Me? I call errors, mistakes and poor outcomes by their real names: errors, mistakes and poor outcomes. And given that healthcare errors and mistakes are the 3rd leading cause of death in America suggests we all should be calling a ‘duck and duck.’

But What Exactly are Patient Safety and Quality of Care Measures?

Examples of patient safety and quality measures include: wrong surgery on the wrong patient, blood infections acquired in the hospital, patient falling from their hospital beds, and many others. And hospitals care about these things because they are trying to make people better, not worse! And yet, studies have shown that more that 100,000 Americans die every year from poor quality—either from delayed care, misdiagnosed problems, hospital-acquired infections, falls and the like. That’s equal to 3-4 jumbo jet airliners falling out of the sky every single day.

Organizations measure these things—and strive to perform at 100% or, at an “A+” standard…No clinician wants patients to fall from bed, or get an infection, or receive the wrong treatment. But most hospitals do not reach 100% or “A” grades on all the quality measures. No. Most hospitals have a mixed grades on their ‘report cards’…And, these mixed grades never seem to get better…years can go by and a hospital’s report card still has a mix of “A’s,” “B’s,” and “C’s or D’s.”

Patient Safety and Quality Healthcare  is Not  ‘a Journey.’

When I was consulting on healthcare system’s Quality, Safety and Risk efforts, most hospitals had mediocre grades, along with some good grades. But regarding the poor grades, I was often told that ‘quality and patient safety is a journey and that it will takes years to improve.’

Maybe…

But…

Since when are hospitals and clinics in the ‘journey’ business? I thought they were in the ‘delivery’ business….You know: a patient comes in for a surgery and the doctor performs the surgery—as scheduled. Patients don’t come to hospitals expecting to go on a journey towards their intended surgery…Patient’s come to hospitals expecting everything to already be in a state of excellence and that the surgery will occur as scheduled and as planned—safely and reliably...Patients believe that their hospitals are safe already, and have already ‘arrived’ at their patient safety and quality destination. (Just like with the airlines--passengers expect their pilots and aircrafts to already be safe...)

And…

If hospitals are on a ‘patient safety journey’ when exactly are these hospitals arriving at their destination? Aren’t all journey’s time-bound? When you go on vacation, isn’t there a start and end date? So, if achieving reliable patient safety and high-quality is a destination, when is the arrival date?

Three Ways To Improve Safety and Patient Quality…

I’ve come to believe that there are only three ways organizations will actually take ownership of mediocre scores and ‘arrive’ at the promise-land of high reliability and zero medical errors.

Firstly, the organization’s leadership must have a true, authentic belief that quality of care is critical and vital to survival.  Leaders must believe that zero errors is achievable and takes the highest priority in the organization.

Secondly, prioritize quality and patient safety above financial rewards, executive compensation or shareholder demands. Not one organization that I’ve worked for, or consulted for, has ever put quality and safety above financial metrics.

So, since the leadership can’t be counted on to ensure the safety of hospitals (rings a bell too for Boeing…) then the public must be involved, which is the third way:

Thirdly, have the public understand what is going on and ways to help themselves stay safe. To help with this, I’ve put together a short list of ‘to-do’s’ if you find yourself or family members engaged with healthcare in the US:

1.       If you are having a surgery done (such as hip replacement, or gall bladder removal), ask your surgeon what their complication rate is for the year or for last year, what their infection rate is for the year or for the last year, how many of these exact surgeries have they done in the last year. These are the three must-ask questions. And you should know what the industry standard is, which is searchable on the web. So for example, with hip replacement surgeries, if the industry standard for infection is 0.5% and your surgeon’s is 5%, then I’d keep shopping around…

2.       Check your hospital’s publicly reported quality and safety record. Those can be found at https://www.medicare.gov/care-compare/?redirect=true&providerType=Hospital

3.       Do your homework to understand your condition and try to understand what the ‘best practices’ are and what the ‘evidence’ says about the best way to manage your condition. There are many consumer-oriented websites that help breakdown technical information so that the layperson can understand it!

4.       DYI. If you can do it yourself, then do that. For example, if you can heal at home instead of the hospital, do that. It is not safer to spend a night in a hospital if you can heal at home. If you can get better by changing your diet instead of taking a pill, do that. Pills have side-effects…

5.       Do get regular check-ups to catch problems early. The US healthcare system is better at simple problems than complex ones. Try to keep your health ‘simple.’ Move your body every day. Gardening, walking, dancing or anything that brings a smile to your face is medicine for your soul and you don’t need a doctor’s note to do it!

And finally, do build community and friends—loneliness, isolation and boredom can lead to less well-being and happiness…doctors and nurses are generally nice people, but they are no substitute for friendship and engagement in things that matter to you.

About the author: Julie Kliger is recognized by LinkedIn as a "Top Voice" in Health Care in 2015 & 2106, & 2107. She is a Healthcare ‘Strategic Realist’ who is passionate about improving health care and improving lives. She specializes in future-oriented healthcare redesign, optimizing existing operations, implementing new care models and strategic change management. She is an advisor, clinician, health system board member, speaker and author.