Patient Safety, Respiratory Compromise

“Good” Hospitals Require Real Leaders

The following is an excerpt of an article written by Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety). It first appeared on Healthcare Business Today on April 9, 2017. To read the full article, please click here.

As the Executive Director of the Physician-Patient Alliance for Health & Safety, a non-profit whose mission is the improvement of patient safety, I am often asked how to tell a “good” hospital (i.e. patient safe) from a “bad” hospital (i.e. unsafe).

In thinking about “good” and “bad” hospital leadership, I am reminded of two discussions I had with hospital leaders – which leaders’ hospital would you rather be a patient at or, if you are a clinician, work at?

I spoke with the CEO of a hospital, who was dealing with the family of a child that had died within the hospital from opioid-induced respiratory depression. His clinicians had not employed continuous electronic monitoring with pulse oximetry for oxygenation or with capnography for adequacy of ventilation.

Hearing this, I pleaded with him to implement continuous electronic monitoring. In addition, to countering the bad press his hospital was receiving and the resulting loss of patients and revenues (which seemed more his concern), I offered to have medical and advocacy leaders, including myself, stand on the doors of his hospital (after he had made changes) and endorse his hospital’s commitment to patient safety. He resolutely refused to make these changes, believing that he and his clinicians had acted appropriately, and was reluctant to meet with the family.

In another conversation at a large hospital chain, the Quality and Safety Officer told me that on the occurrence of any adverse event or death, a SWAT team of administrators and clinicians immediately start identifying what had happened and speaking with the patient and family. This SWAT team is then responsible for implementing any necessary changes in hospital procedures.

Leadership throughout the hospital – whether at the executive level, in the ICU, or in a nursing unit – affects the organization, its people, its patients, and its visitors. And leaders must set the tone for their organizations from the executive level, as well as in units and teams within the clinical setting, otherwise adverse events and patient deaths may ensue.

My discussions with the CEO and the Quality and Safety Officer illustrate the difference between “highly reliable” organizations (HROs) and those that are not. Although we would like to think that our hospitals are HROs and are more like that of the quality and safety officer and less like that of the CEO’s, the reality may be the reverse. In thinking about my discussions with the CEO and the Quality and Safety Officer, two things strike me.

The first is an observation of process and protocols. One of the main goals of my meeting with the Quality and Safety Officer was the use of the PCA Safety Checklist in his hospital. The PCA Safety Checklist was developed with a group of 19 renowned health experts and provides recommended steps when initiating and continuing patient-controlled analgesia (PCA).

The second is that processes are really only as good as the people who implement them. In the hospital of the Quality and Safety Officer, there is a culture of safety (the “people” factor) and an accepted process for ensuring that the goal of safety is continually pursued (a checklist, for example). So, in regard to the PCA Safety Checklist, we discussed how the Checklist ensures essential steps are observed. However, a culture of safety relies upon the intervention and judgment of clinicians. For example, if continued PCA administration might lead to respiratory compromise, the intervention of a clinician is needed to adjust medication selection or dosing.

In thinking about my discussions with the CEO and the Quality and Safety Officer, “good” leadership goes beyond the adherence to protocols and checklists. There is also a stark contrast in attitude.

On the one hand, the Quality and Safety Officer sees each adverse event and death as a learning process. He wants to know what happened and to learn whether there are improvements that could be made. He trusts the people around him and believes the SWAT team will be able to perform both of these tasks. Moreover, he wants to share this with the patient and family involved.

On the other hand, the CEO takes a completely defensive posture. There is no desire to learn from what happened or to improve on existing practices. Moreover, there is no desire to engage the patient or family.

So, how can you tell the difference between a “good” hospital and a “bad” one?

If you are a patient (and we are all be patients, whether we are clinicians or not), there are hospital safety scores out there, such as the LeapFrog Hospital Safety Grade which allows users to look up a hospital and see how well that hospital is graded. For better or worse, these grades are limited to “how safe they keep their patients from errors, injuries, accidents, and infections.”

And, if you are a hospital leader, The Joint Commission has set forth 11 steps to achieve a patient safe culture.

So, the next time I am asked the question – “How can you tell a ‘good’ (i.e. patient safe) hospital from a “bad” (i.e. unsafe) hospital?” – I can answer, just look to its leaders and see whether they are patient safe.

This was an excerpt of an article written by Michael Wong, JD (Executive Director, Physician-Patient Alliance for Health & Safety). It first appeared on Healthcare Business Today on April 9, 2017. To read the full article, please click here.

Leave a Reply