1. Gretchen LeFever Watson: Improving patient safety, hospital profits
Apr 3, 2016
GUEST COLUMNIST
IF YOU AREN’T worried about being hospitalized, you should be. Each year, U.S. hos-
pitals harm 1.5 million patients and needlessly kill 440,000 — a rate of injury double
what it was when federal funding was first directed toward improving patient safety.
Members of two Senate committees requested a Government Accountability Office in-
vestigation on the lack of safety progress. According to the new GAO report, hospitals
face three challenges: (1) time and resources to collect information about their errors;
(2) deciding which practices will make hospitals safer; and (3) ensuring consistent use
of safe practices by staff.
Writing for Forbes magazine, Leah Binder — CEO of a national consortium of business executives who advo-
cate for hospital transparency and safety — lamented recently that health care leaders have been mum about the
report. Why? According to Binder, our traditional fee-for-service payment system means “the more harm, the
more payment.”
Binder characterized the GAO findings as embarrassing: “When thousands of people are dying from preventable
errors, is it too much to ask hospitals to read the latest research? It’s as if the house is burning down with people
inside, and the fire department is confused about which room to attack first, and which hose to use. Worse, the
chief isn’t sure the firefighters will do the job.”
Binder’s exasperation is justified. The research is clear about how to eliminate many medical mistakes, including
hospital-acquired infections, medication-administration errors, and off-the-mark procedures (surgeries and oth-
er invasive procedures involving the wrong patient, wrong body part, or wrong procedure).
As a group, infections, medication mix-ups and surgical mishaps represent hospitals’ most prevalent, predictable
and preventable medical mistakes — a trifecta of sorts. Strategies to prevent this trifecta of patient harm require
-consistent use of simple and essentially cost-free behaviors like washing hands before entering and after exiting
patient rooms and using a standard time-out checklist before surgery.
Noncompliance is costly. Health care-acquired infections alone result in $28 million to $45 million excess annual
health care costs. Published data have shown a 1 percent increase in the rate of hand-washing by staff will save an
average-sized hospital $40,000 per year just in costs associated with a single type of infection — Methicillin-resis-
tant Staphylococcus aureus, more commonly referred to by its acronym MRSA (pronounced mursa).
It is understandable that during the hustle and bustle of complex and complicated health care work, oversights
can and do occur. Given their grueling workloads, providers will also be tempted to bypass precautions that
sometimes seem too simple to matter. While fee-for-service payment may not adequately incentivize hospitals to
get a better handle on oversights and shortcuts, this is a hard pill for the general public to swallow.

2. If more patients understood that simple habits could save hundreds of thousands of lives each year, they would
demand their consistent use. Instead, critical safety steps are frequently skipped and patients rarely speak up.
U.S. hospitals have modeled their safety programs after other high-risk industries that have achieved stellar
safety records, but health care is unique. It centers on people, and people cannot be controlled to the same degree
as equipment (airplanes), physical structures (nuclear power plants), or material (chemicals). Hospital safety
depends on consumer engagement.
Health care’s consumers become a dynamic part of the system the moment they walk, or are wheeled, through
hospital doors. Although hospitals now admonish patients to speak up for safety, their approach amounts to too
little too late. Offering patient education during the anxiety-ridden hospital experience is like telling a child to
behave during the throes of a temper tantrum.
Long before being hospitalized, all of us must learn specific steps to take when a basic oversight is observed.
When we see a nurse neglect to wash his hands, for example, all it takes is a line like this one: “I’m glad you’re
here. To make sure I don’t pick up an infection, would you mind washing your hands?” And providers must be
equally prepared to respond approvingly to such “intrusions” by patients and their loved ones.
Ironically, much of the work required to improve safety within hospitals must occur outside of them. By timely
offering the public manageable steps to unite patients and providers in the journey toward safe care, we can cut
the rate of harm by 50 percent within five years — a national goal that we have not come close to achieving after
more than 15 years of effort.
Gretchen LeFever Watson is a clinical psychologist, adjunct professor at Old Dominion University and president of
Safety and Learning Solutions.