Healthcare providers would get smaller pay increases when caring for the elderly, poor and disabled under President Bush's budget plan submitted to Congress. The recommendations, if adopted, would trim Medicare spending by $66 billion over five years. That means the healthcare program for seniors would grow at a 6.7 percent clip rather than a 7.6 percent rate, budget officials said.
Leaders love to use lines like, "Mistakes are never one person's fault," or "Medical errors are the result of process breakdown, not people breakdown." But how do you tell that to the millions of people who suffer medical errors each year? Try boasting about your blame-free culture to the three patients at a Rhode Island hospital who experienced wrong-site brain surgery last year, or to actor Dennis Quaid, whose newborn twins were given 1,000 times the intended dosage of a blood thinner last November.
Don't get me wrong: I know that going blame-free has its advantages. Most organizations agree that near-miss reporting goes up and errors go down when information is anonymous and nonpunitive. But how does your reporting system identify threats to patient safety? How do you ensure that people are blamed when they should be--thereby ensuring that the same errors don't happen twice?
At Virginia Mason Medical Center in Seattle, CEO Gary Kaplan doesn't care for the term "blame-free." He's a believer in what he calls the "fair and just" culture--an environment in which people feel safe to report accidents and near misses but also understand that there will be accountability. Kaplan's system (which I wrote about in the December issue of HealthLeaders magazine) hasn't reduced the number of reports they receive--the number's actually gone up. But it ensures that the right people are held accountable and, when necessary, removed from a process when they might be endangering it.
Accountability can get even fuzzier when compensation is linked to patient safety. Organizations implement elaborate reporting processes but then base a portion of staff's annual pay increases on improving, say, hand washing. How do you convince nurses to report their non-washing colleagues if a portion of their paychecks depends on documented hand-washing compliance? One way to encourage more reporting is to make near-miss reporting itself a goal linked to compensation, as leaders at Sarasota Memorial have done. Sarasota's goal in 2007 was to increase error-reporting by 10 percent. (At year's end, reporting had gone up 7 percent.)
"Blame-free" shouldn't mean "not accountable." Healthcare leaders need to find a way to hold people accountable--when necessary--without scaring people into silence or creating an environment of finger-pointing. And reporting processes, although nonpunitive, should have a way of identifying risks--in the form of both process and people. This isn't an easy balance to strike, but it's an important one. Lives, after all, depend on it.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
Mark D. Shugarman, a veteran hospital administrator and former head of Mercy Hospital Clermont in Batavia, OH, was been named the new president and chief executive of Floyd Memorial Hospital in New Albany, IN. He will replace Bryant R. Hanson, who was hospital CEO for 17 years before announcing his retirement.
Birmingham, AL-based Children's Health System has achieved "magnet recognition" from the American Nurses Credential Center. Children's is only the second hospital in Alabama to earn the distinction, with UAB Hospital achieving magnet status in 2002. The hospital spent four years preparing for the program and had an extensive site visit last year for officials with the national nurse organization to review the hospital's nursing practices.
Accused of fraud and perjury, with court documents indicating he suffered from memory lapses that were getting worse, heart surgeon Alex Zakharia promised to retire and surrender his Florida medical license by Dec. 31, 2007. Five weeks after the deadline, the 70-year-old doctor was still practicing at his South Miami office. Zakharia has also renewed his lawsuit against Cedars Medical Center, which suspended him in November 2006 following the deaths of several patients, court documents show. The doctor is accusing the hospital of "malicious" and "bad faith" conduct.
More people survive major heart attacks with fewer problems if doctors use a mini-vacuum to clear out an artery blockage instead of pushing it aside to restore blood flow, according to a Dutch study. The study is the largest to date to show that suctioning out the clot before implanting a stent has benefits, and could lead to wider use in heart attack treatment.