Until Peter Betts came to Barnert Hospital in Paterson, NJ, in July 2007, he did not realize just how dire the financial straits were at his hospital, one of the two main medical centers in this struggling city. On the same day, the Bayonne Medical Center completed an agreement for its sale to a limited liability corporation that would assume the bulk of its debt. What has happened in Paterson and Bayonne paints a vivid picture of the distressed situation of New Jersey's hospital industry.
Officials have announced that two Newark, NJ, hospitals would be shut down before summer 2008, and their services would be consolidated with St. Michael's Medical Center. The three hospitals, owned by Cathedral Healthcare System, were losing $6 million a month, according to the company taking them over. But angry residents and elected officials say the closings will leave parts of Newark without vital services for a community with many immigrants and poor people.
Maryland is considering legislation that would require families to report proof of health insurance coverage for their children on their tax filings, and beginning in three years families with uninsured children would no longer qualify for the state's child tax exemptions. The "Support the Kids First Act" is designed to help the state identify which children are uninsured.
The Loudoun County (VA) Board of Supervisors last week approved Inova Health System's request to build a medical campus in the southern part of the county. But construction will depend on the outcome of court hearings set to begin on a project by Hospital Corporation of America. HCA is seeking to build a medical campus less than half a mile away from Inova's site.
Greensboro, NC-based Moses Cone Health System has formed an alliance with Wake Forest University Baptist Medical Center in Winston-Salem. The two will form a nonprofit company so they can share information and buy supplies in bulk, among other functions. The goal of the alliance is to improve health-care quality and reduce costs, say representatives from the two providers.
President Bush's proposed cuts in federal spending to train pediatricians could spell disaster for education programs at Cincinnati Children's Hospital Medical Center and make a national shortage of pediatricians even worse, said hospital officials. Bush's federal budget request would cut all funding for a program that trains 4,700 pediatricians and pediatric specialists a year. If Children's loses the federal money for training physicians, administrators say they will have to choose between training fewer physicians or taking money away from patient care to maintain the program.
A new director is about to start work at Carolinas Medical Center's ALS center, even as longtime patients continue to complain about the abrupt firing of Jeffrey Rosenfeld, MD, the center's founding director. In 2007, Rosenfeld took the unusual step of suing his former employer, claiming breach of contract and defamation of character. Charlotte, NC-based Carolinas Medical Center has denied the allegations. Since Rosenfeld's firing, some patients have criticized the hospital for removing the doctor, whose reputation drew patients from around the country.
Norway faces a growing shortage of healthcare staff over the next 5-10 years, and by 2020 a large number of post-World War "baby boomers" will have left the workforce. To help with the problems, two employee groups have teamed up to see how robots and other hi-tech gadgets can be developed to help care for the elderly.
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.
