Looking at surgery as an example, our research suggests that the road ahead for improving patient safety will look different from the road behind. We propose that older approaches to advancing surgical safety, focused on technical and structural improvements, have passed their peak; attention must now turn to innovations in how people enact their work "on the ground," or how they organize in real time for reliable surgical performance.
In 2009, Boulder became the first county in the nation to merge its housing and human services functions into one single agency. In doing so, Boulder put itself among the vanguard of places that were beginning to focus on the social determinants of health -- the idea that it's fruitless to address community health without also tying in things like food security, transportation access, rehabilitation services and employment.
Many medical professionals and policy makers are challenging the wisdom of asking patients to rate how hospital employees manage pain. Doing so, they argue, creates a dangerous incentive for doctors to prescribe powerful and potentially addictive painkillers.
The Food and Drug Administration does not regulate surgical procedures. So what happens when an operation is subjected to and fails the ultimate test — a clinical trial in which patients are randomly assigned to have it or not?
At the Henry Ford West Bloomfield Hospital outside Detroit, patients arrive to uniformed valets and professional greeters. Wi-Fi is free and patient meals are served on demand 24 hours a day. Members of the spa staff give in-room massages and other treatments. While clinical care is the focus of any medical center, hospitals have many incentives to move toward hotel-inspired features, services and staff training.
For all its promise, immunotherapy for now brings more disappointment than marvel for the majority of patients. The end of this story, sadly, allows no easy ebullience. Not for medicine. Not for Jason. [Registration required.]