Hospitals are scary places. People might not dare walk in to ask for help if they knew that they had a high chance to die from preventable medical adverse events. Some hospitals are worse at it than others, but which ones? Patients are in the dark because there is no data to make an informed choice. A patient frequently has more information about the rate of success of the mechanic taking care of his car than is available about the effectiveness of the care provided at hospitals. Those who have a choice, they make a decision on the basis of what they can see, like the celebrities being attended there, the size of the hospital, perhaps even a piano being played live in the reception lounge, while corpses are delivered through the back door.
So, what is so wrong? Part of the problem is ineffective people management. We are used to muse about the glamorous high-level challenges of managing people, like strategic fit. But if people managers were to put their noses into operations too, they might find many ways to help to save lives by helping to improve hospital care.
We have a systemic problem and it is not only driven by insufficient funding or inefficient spending — the size of the problem, and the fact that it largely has to do with people, offers people management a lovely challenge to do good by doing well
But in first place, is the problem large enough to worry? Yes, it is, all over the world. Even in the European Union, close to 8 percent to 12 percent patients admitted at hospitals suffer from events that could have been avoided. Naturally, it is worse in developing countries where health care-related infections may be 20 times more frequent. In Brazil, close to 320 thousand die every year because of adverse effects stemming from medical errors. Adjusting for population size, the challenge in India might be three times as large as in Brazil. We have a large problem and the disparities between countries and hospitals suggest that one solution might not fit all.
Some problems are common to all developing countries. According to Dr. Reddy1 of KIMS-NKP, developing countries account for 77 percent of all reported cases of counterfeit and substandard drugs. But again, why would a hospital carelessly buy and administer substandard drugs? Naturally, they are cheaper, but that is precisely because they don’t work as well as standard drugs. Similarly, with medical equipment, Dr. Reddy has argued that in India over half of it is not working properly or at all, resulting in substandard diagnosis and therapy. Almost 4 billion injections are applied in an unsafe manner every year in India, but the problems are also associated, as in Brazil, with the wrong prescription of the drug injected, its dosage, the time of day when it is administered or the interaction of the prescribed drug with other drugs the patient is taking. Frequently, all the latter are correct but the drug administered was not the one prescribed; so many similar drug names result in people making mistakes.
Sometimes the adverse effects that kill or maim arise from poor communication among staff, i.e. errors are higher when patients are handed-off in shifts, either to other nurses or other doctors.
It is easy to blame the hospital medical and nursing staff, but it will not help solving the problem because none of them would have studied as much and accept working under so much responsibility and stress only to let their patients drop dead. To an important extent hospital staff is not knowing what goes wrong in their own hospital nor who is responsible for what. All hospitals have lurking procedural flaws that only cause an adverse effect when several events tragically align themselves.
We have a systemic problem and it is not only driven only by insufficient funding or inefficient spending. The size of the problem, and the fact that it largely has to do with people, offers people management a lovely challenge to do good by doing well.
In most developing countries, we do not really know what is going on inside hospitals. We need to introduce better statistics to know what is going on when and where. Poor communication between work teams is also an issue. We need to introduce better controls to check for medical compliance, and more transparency in the reporting of mistakes, to learn from them. All these are a part of the people management repertoire, including that medical adverse effects that continue to kill and maim is also the responsibility of people managers.
People management issues make some hospitals better than others at stamping out mistakes. For instance, the variation between the American hospital faring worst in the mortality rate within 30 days of a heart attack is only twice as bad the top ranking hospital. But the variation of mortality rates after colon cancer surgery among Swedish hospitals is ten times as large. Clearly, there is scope for a plenty improvement in many Swedish hospitals when it comes to the effectiveness of cancer-related colon surgery.
Clearly, it is people who make the mistakes, but their management can improve and better people management an, in turn, save lives
But such data would not be available without improved people management oriented towards monitoring performance in issues like communication, safe work protocols, teamwork effectiveness, staff selection and training, compliance with routines, information gathering and transparency in reporting. The latter works as a lighthouse, signalling trouble. Without it, hospital managers do not know what course to take. For instance, the improvement in the quality of outcomes for myocardial infarctions at Swedish hospitals was slowly improving for all hospitals during 2005 and 2007, but it improved sharply after the performance data for all hospitals was made public in 2007. It is not only about competition and shaming, but figuring out who is performing how poorly.
Clearly, it is people who make the mistakes, but their management can improve and better people management would save lives. Is that not something we would like to work on?
1 Dr Narra Gopal Reddy
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