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Op-ed: The Invisible Pandemic

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Kathleen Bartholomew, RN, MN

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.” )

Lessons from Nursing to the World | Kathleen Bartholomew | TEDxSanJuanIsland Jan 26, 2016

Bibliography

Bartholomew, K. (2014) Ending nurse-to-nurse hostility. HCPro, Danvers, MA

Study of over 5000 heath care professionals over 5 years demonstrating that 95% do not voice their concerns

James, J. T. (2013) A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety 9(3):122-128. 440,000 deaths per year

Mackary, M. (2016) Medical error – the third leading cause of death in the US.  BMJ 353:i2139

Martinez, W. et al (2017) Speaking up about traditional and professionalism-related patient safety threats: a national survey of interns and residents. BMJ Quality Safety, Nov.; 26(11) 869-890.

Pilcher, C. MD. Interview as Seattle expert witness for dozens of cases in which hush money was paid.

Souba, W. (2011). Perspective: A New Model of Leadership Performance in Health Care. Academic Medicine, 86, 1241-1252. http://dx.doi.org/10.1097/ACM.0b013e31822c0385

Of 254 Chairs of medicine and surgery 69% reported ‘common or widespread for people to not raise or talk about important problems

Should Malpractice Settlements Be Secret? Mello MM, Catalano JN. JAMA Intern Med. 2015;175(7):1135-1137. doi:10.1001/jamainternmed.2015.1038 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2293075

Extracting Medical Injury Information from the Legal System to Improve Patient Safety in the Health System: A Social Utility Approach, Chaffee, M. U. Mass. Law Review Vol. 11: Iss. 2, Article 5.  Available at: http://scholarship.law.umassd.edu/umlr/vol11/iss2/5 mwchaffee@aol.com

More than money: motivating physician behavior change in accountable care organizations. Phipps-Taylor M, Shortell SM. Milbank Q. 2016; 94(4):832-861. doi:10.1111/1468-0009.12230

Malpractice Liability and Quality of Care: Clear Answer, Remaining Questions. Sage WM, Underhill K. JAMA. 2020;323(4):315-317. doi:10.1001/jama.2019.22530 https://jamanetwork.com/journals/jama/

6 thoughts on “Op-ed: The Invisible Pandemic

  1. Thank you for speaking up. I have been saying the exact same things for years now, and more recently as C19 has taken the spotlight and been blamed for everything! With the draconian measures now in place that do not allow family to stay at the bedside for safety, I fear even more deaths will result from poor care and errors.

  2. It’s NOT invisible. It’s right there for people to see. But it’s buried. I am a community/rural Pediatric Hospitalist – and have been fired for medical-whistleblowing three times in 22 years (each time reporting a “bad baby” case) – most recently this past January – force to work out a notice I did not give. At the time it happened, we were under-staffed (after a nursing meltdown – instigated by management) and resources were cut to the bone. I originally reported internally and up the chain-of-command. Was out of my job less than two days later – fired on a Sunday night over the phone. I reported what happened to the NC Department of Facility Services (and by default CMS). Six months later (long after I was gone), they showed up and cited-as-a-deficiency the very case I was fired for reporting – plus another that proved that, at my end, this hospital could not even properly feed a baby overnight. The report is public record (http://www.hospitalinspections.org/report/27810) – and makes NO MENTION of the PUNITIVE ACTION taken against the doctor who intervened and reported the case (me). THEN the parent company (affiliated with a really BIG name in medicine) black-listed me on another job. I cannot do this anymore. I have to have safety, security and freedom-to-speak/report on-the-job. We on the front-lines have got to have some help.

  3. The author is correct about the economic incentives leading to less safe care, but there is another major problem as well. The licensing and peer review systems don’t work very well to protect the public.

    The medical professions are essentially self-regulated. Physicians dominate state medical licensing boards, dentists dominate state dental boards, etc. Analysis of the actions they take and the penalties they impose shows that most of the boards seem to be more interested in protecting questionable or bad physicians, dentists, etc., than they are in protecting the public. Few serious penalties are imposed and practitioners are given second, and third, and and so-on chances seemingly routinely. To fix this, licensing boards should have no members who are in the profession they regulate; if special technical expertise is needed for a particular case, they should hire an independent expert from another state.

    Hospital peer review has a similar problem. There are even fewer peer review actions taken than there are licensing actions. Peer review is a good idea, but it has been implemented in a way that has the fox guarding the hen house, just as with licensing boards. Peer reviewers should be truly independent. Physician peer reviewers should be from outside the state where the hospital is located and have no ties of any sort to the hospital or physician(s) under peer review.

    1. The HCQIA of 1986 protects all hospital peer review activity from discovery and from the public. This legislation effectively silences all but a few brave physician and nurse whistleblowers – who often become disemployed by hospitals, pilloried by state medical boards (the hospitals’ enforcers), and memorialized with a NPDB epitaph…

  4. The comparison to police is right on. Nurses fired all the time. Cops occasionally, but when they are ,,they are not de certified . The alarming number of nurses who are revoked over petty issues is alarming . Just look up the state agency on the OAh site . Rare Peace officer standards take one to court. The cop just moves on to the next department / prison/ private investigator while the nurse is scarred for life. Once acted on and reported to data bank they cannot even volunteer . Affects the rest of their lives and mostly the complaint it about the nurse reporting unsafe conditions . Happens to docs but not as often. YUMA medical center been using the BON to take nurses down for a long time and now went after a Doc during covid crisis , a war hero . and it rightly back fired on them !!! WHo would work in YUMA now???? https://kyma.com/news/top-stories/2020/12/11/yuma-doctor-claims-he-was-fired-for-talking-about-covid-19-in-arizona/

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