Recent efforts to make hospitals safer seem to be paying off. The goal is an ambitious one, to say the least: to reduce hospital-acquired conditions by 1.8 million from 2014 to 2019, a 20% reduction that will save 19.1 billion dollars in hospital costs (Centers for Medicare and Medicaid Services). Optimism is growing that this goal may be attainable.
In a report released on June 5th by the Agency for Healthcare Research and Quality, more than 8,000 lives were saved as a result of fewer mistakes made in hospitals from 2014 to 2016 (modernhealthcare.com). According to the Washington Examiner, “the drop in those mistakes, which include infections spread in hospitals, falls, and improper medications, reduced costs for hospitals by 2.9 billion dollars. [The AHRQ] estimates that the mistakes, known as ‘hospital-acquired conditions,’ fell by 350,000, a reduction of 8 percent from 2015 to 2016.” Selma Verma, the CMS administrator, called this a “tremendous accomplishment.”
Any efforts to reduce in-hospital mistakes must also address the problem of widespread physician burnout, because burned out doctors are more likely to commit errors. In a 2017 paper, the National Academy Medicine cited links between doctors’ disaffection and the care they gave patients (The Wall Street Journal,, June 11, 2018). “Telling doctors to eat granola, do yoga, and be more resilient isn’t going to address the problem, says Tait Shanafelt, who was appointed chief wellness officer of Stanford Health Care a year ago. Instead, hospitals need to reform a system that has become debilitating to physicians — and left patients vulnerable to medical errors and even malpractice, Dr. Shanafelt says.”
Reducing physicians’ clerical duties will be a step in the right direction, but “even that may not be enough to dispel burnout,” says Dr. Shanafelt. “Physicians have lost a sense of community and are feeling more alone than ever, he says: We are interacting with our patients less. We are interacting with out colleagues less. We are becoming more isolated.” To illustrate, Dr. Shanafelt points out that “hospital physicians’ lounges, where doctors could meet, unwind and discuss cases, have largely vanished.”
Building a renewed sense of community among physicians must include a willingness to admit their mistakes, says Dr. Chandry C. John of Indiana University School of Medicine. “We need to work toward a different culture, one in which we openly acknowledge our own mistakes and acknowledge that avoiding them is completely impossible” (JAMA, June 12, 2018). Here’s Dr. John’s advice: “Acknowledge the error. Apologize to your patient and family for making it. Forgive yourself. Learn from the error. Teach others about it. Model vulnerability.” The benefit, over time, he adds, will be that the frequency and magnitude of physician errors will tend to become smaller.
Although all physicians strive to “do no harm,” being perfect in this regard is simply not achievable. Instead, every doctor’s goal, says Dr. John, should be “do as little harm, and as much good, as is humanly possible.”