This question surfaces instinctively when we face situations where the possibility of danger is real and apparent. Climbing mountains, riding 100-year-old rollercoasters, and coming face-to-face with wild cats are activities fraught with danger: knowing that, we will have taken precautions. But we will also query the reliability of mitigation actions of those in charge, the ones we deem responsible, and ask them, “Is it safe?—generally assuming that the answer will be “Yes, of course it’s safe.”
But rarely do we walk into a hospital or a doctor’s office and ask that question. Of course, a hospital is safe. Of course, we are safe if we put our lives into the hands of a doctor, or entrust them to a system designed to guard our health and make us well. Of course.
Unfortunately, however, and with shocking frequency, the answer to this rarely-asked question is too often, “No.” No, this place is not safe. No, this place is filled with people, driven by systems, and fuelled by processes that make the environment inherently unsafe for many of those people who enter so trustingly: the patients.
Let me pause. “Yes, I see that hand in the back. Your question, sir?”
“What do you mean, hospitals aren’t safe? Do you mean hazards such as water on the floor and electrical cables hanging from the ceiling?”
No, I’m not talking about that kind of danger. Not the kind you’d find on manufacturing floors with whirling blades or on construction sites with bricks falling from the sky and giant machines racing about bent on squashing you. Nevertheless, I’m talking about danger just as real—although lurking largely unseen—with implications for safety every bit as real.
I am talking about real danger, but it is often a danger hidden behind systems and screened by our lowered expectations. You see, in a place like a construction site, if someone dies or sustains serious injury, people take notice. No one can see a worker at the bottom of a hole with a piece of rebar sticking in his side and just say, “Oh, that’s a shame, but, after all, these things happen.” Instead, people take action, first to rescue the man and then to ensure that this never happens again. In fact, if remedial action isn't taken, the site will likely be shut down and the construction company in for some serious trouble.
But what happens if something unsafe happens in a hospital? Something like failure to wash hands, spreading some dread bacteria from nurse to orderly to patient. And what if this dread bacteria turns a patient who is on the mend from surgery into a patient fighting for her life because of an infection? That kind of environment is unsafe. But this lack of safety often goes undetected in the midst of expected results. Environmental camouflage disguises the lack of safety.
Hospitals are places where sick people go, places where dying people often end up. One might wonder, “How are we to tell the difference between people running through the natural course of the end of their lives and those who are artificially hastened along their way through bad process, uninformed decisions, or negligence?”
On the day that I write this, a young man from Winnipeg is fighting for his life. He is in intensive care and on life support because of complications due to a wisdom tooth extraction. “People get complications,” you might remark, “so why is this a special case?” It is special because his complications are the result of someone on his medical care team making an error: the patient did not get a post-surgical prescription for antibiotics along with the prescription for pain killers that he did indeed receive. Because of that, he got an infection, one which went untreated because no one knew to look for it. The original error was compounded by subsequent actions—or lack of action—based on the assumption of a safe environment. The young man and his caregivers expected him to be safe in the hands of his medical team, but someone—perhaps many—let him down. At this time no investigative results have been made public, so not all the facts are apparent. The sources of error remain to be seen, but what we do know is that the patient who expected to be safe in the wake of a major but routine operation is now at risk of dying.
Of course, not all doctors make these kinds of mistakes. And not all hospitals foster environments which allow mistakes to happen and then compound themselves. Nor do all allow such disturbing issues to be glibly dismissed as one of those “things that just happen.” However, while I’d love to say this is an isolated case and events of this magnitude rarely happen, that is simply not true. In 2013 alone, one-half million people died in hospitals in North America from medical errors: half a MILLION! And that is only the people who died. There are countless others, perhaps millions, who have suffered permanent harm—physical, psychological, or both—from errors that happened in hospitals at the hands of people they trusted to provide them with medical care.
Hospitals should be safe places. Safe places for those who are sick to be admitted and get well. Safe places for people who are dying to receive quality palliative care. Safe places for the elderly to receive care for critical issues even while their bodies, overall, are failing them over time. Tragically, for far too many people, this is not the case.
What can we do? Well, to start, we need to demand transparency from our healthcare providers: from doctors and hospital administrators. We need to ensure that legislators are requiring full disclosure of errors and demanding good plans to ensure that system errors get fixed.
We also need to demand that doctors and other caregivers acknowledge what we already know: that they are not infallible and that they make mistakes. It is simply arrogant to believe and say anything other than this. Assuming responsibility for error and making apologies are critically necessary.
But we must not simply focus on those people who need more humility and institutions that are in need of improvement; we must also find ways to celebrate the places and people who are already doing it right. Let’s acknowledge the medical professionals who practice safety and transparency and model that to others, the administrators and policy makers who put patient safety high up on their priority lists when implementing change. Because, in the end, it is not legislation alone, nor just promises to change, that will make places safe. Widespread safety first requires that people and institutions actually change; then, that they model those changes to other institutions and medical personnel, including those in training.
I was recently at a patient safety meeting where Martin Hatlie, CEO of Project Patient Care, described a process one American hospital had put into place for dealing with errors in patient care:
1) Within 30 minutes of an error, it is reported.
2) Within 30 minutes of report of error, medical and hospital personnel are meeting with the patient and/or her family to admit an error has occurred.
The results will pleasantly surprise you. Not only did these simple steps (representing but one of many progressive initiatives implemented at this hospital) increase the level of trust that patients had in their caregivers, but it also decreased the number and size of lawsuits. Furthermore, it allowed this hospital to offer more to patients in compensation (financial or otherwise) than they had even asked for.
Why? Well, first, people are less likely to sue an agent who has been upfront about harm that has happened and who has admitted possible culpability. Second, subsequent steps in this hospital’s initiative had the hospital offer to make good to the patient and family if the hospital was determined to be at fault, which meant that lawsuits and lawyers were bypassed. This avoided the huge take previously going to lawyers who were helping to settle—no less than 65% of total costs. Wow! And all of this simply because, within an hour of an error, someone from the hospital was meeting with the family and saying, “Something happened, and although we do not yet know what the implications are or who is at fault, your father/mother/brother/sister/son/daughter has been harmed. We want you to know about it, and we want to involve you in the process of making it right.”
Every patient deserves to be safe. EVERY patient. Let’s start telling each other the truth in healthcare and see if we can’t do better in future than we are doing now—because half a million dead each year is far too many.
His latest book, What I Learned from Cancer, is available in electronic form at his payhip.com site: http://bit.ly/wilfc-ebook. Physical copies of the book are available at the Prompters to Life web store, where shipping on copies of the softcover edition is always free (except to the International Space Station). To order a paper copy of the book, visit: http://prompterstolife.com/shoppers