December 10, 2020
As a nurse and culture expert, I look for patterns. The similarities between what is occurring in health care and law enforcement are remarkable. Both institutions are supposed to keep us safe. Yet both policing and healthcare hide their bad apples in a culture of secrecy. The callous indifference to human life that sparked police reform across our nation was so intolerable that it sparked a revolution. But how will a revolution occur in health care when no one acknowledges the problem?
Physicians, nurses, and administrators want you to be safe. But that hope does not match reality. Hospital errors have been insidiously killing more people than Covid-19 for over a decade while hospitals regularly pay hush money under the table for silence in non-disclosure settlements. Is this acceptable to you?
For over twenty years I have taught the principles of safety to healthcare workers nationwide. However, little has changed because priorities are misaligned. Safety advocates continue to tell stories of patients needlessly dying from our mistakes: the young mother of two who died when the physician didn’t listen to the nurses’ concerns, the nurse whose patient ended up a paraplegic because of her incomplete assessment, or the board of directors that was pleased because ‘only three patients died from our mistakes this year’. There are exceptions, such as the top 100 Hospitals. However, the norm is that thousands of patients die from preventable errors while the general public and unions stand by silent and idle.
Because any hospital’s survival depends on enough income to keep the doors open, finances are the unspoken top priority (especially now when so many hospitals are in the red.) One example of this is staffing grids that dictate how many nurses are allowed per the budget, versus how many nurses are actually requested to provide you with safe, skilled care. As citizens, we have enabled the healthcare industry to morph into profitable businesses that are not beholden to the community while expecting boards to be altruistic. This result is a conflict: the vested interests of executives vs. the best interest of our communities.
New structures must be designed to incentivize hospitals to have a vested interest in keeping their communities healthy. This can only happen if healthcare is primarily a service, rather than a money-making business; a right rather than a privilege (as in a single-payer system where every stakeholder’s top priority is your safety and well-being).
Unless consumers demand transparency, a culture of secrecy will prevail. This culture prevents us from learning from our mistakes and protects incompetent providers. Hospitals must be held accountable for reporting and sharing all errors instead of burying mistakes in non-disclosure settlements. Furthermore, we delude ourselves by expecting that hospitals will openly share their mistakes at the expense of their reputation.
The best of us cannot keep you safe in the current dysfunctional system.
I guarantee you that not one of the over 400,000 patients who have died from our mistakes ever thought it could be them. No one is exempt, and no one will be safe until we replace shame and secrecy with structures based on the values of inclusiveness and integrity that we as Americans cherish.
Kathleen Bartholomew, RN, MN
(Kathleen has been a national speaker for the nursing profession for the past eleven years. In 2010 she was nominated by Health Leaders Media as one of the top 20 people changing healthcare in America. With her husband, John J. Nance, she co-authored, “Charting the Course: Launching Patient-Centric Healthcare.” )
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