Hospitals Should Embrace What They Learned In Kindergarten

10/26/10Follow @venturevalkyrie

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it is a big number either way. Physicians and nurses are required to count the number of sponges that go in and then count them again on the way out. While new technologies such as radio-frequency tags and bar codes exist to perform this function more effectively, most hospitals still do this the old fashioned way—manually. The problems come in when doctor and nurse disagree over the accuracy of the count on the way out, and this is where the mistakes are often made. This process must be improved through the application of technology to take the chance out of it.

3) Wash your hands before you eat. I’ll add a slight change: wash your hands before you touch a patient, This is another basic kindergarten skill that everyone in hospitals should know. Hospital-induced infections are among the highest cost medical errors out there, accounting for an estimated 98,000 deaths per year. Did any of you catch that September 16 article in The Health Care Blog entitled “NYC Train Station Bathroom Yields Cleaner Hands than Hospitals“? In the article Michael Millenson, a visiting scholar at the Northwestern Kellogg School of Management, compared data from a recent survey of public bathroom hygiene in the U.S. to hand hygiene compliance rates in U.S. hospitals, and found that “the guy who just used the toilet at Grand Central Station is … way more likely to have clean hands than the guy walking up to your bed at the local hospital.” If you weren’t nauseous when you got the hospital, this ought to make you throw up for sure.

4) Say you’re sorry when you hurt someone. That’s an oldie, but goodie—you probably started hearing it even before kindergarten. So why do physicians and hospitals decline to apply this basic rule? 35 states have laws offering at least partial legal protection to physicians who apologize to the patient or their family after causing an adverse event. Unfortunately, medical malpractice liability carriers are not quite so empathetic and typically advise physicians against an implied admission of guilt that may be construed from such an apology. This is a shame, because a fair amount of research has been done to prove that when hospitals and physicians apologize for their medical errors, claims can decline by as much as 40 percent and liability settlements are considerably lower than in cases where no apology was offered.

In an article in the AMA publication American Medical News, Douglas B. Wojcieszak (the founder of the Sorry Works! Coalition, which promotes the apology, disclosure and compensation concept among physicians, insurers and hospitals) estimates that only 5 to 10 percent of hospitals nationally are taking the “I’m sorry” approach. Wojcieszak adds that many hospitals decline to publicize their adherence to this policy out of fear of drawing attention from trial lawyers (who are apparently lingering outside the ER having chased an ambulance to the hospital); nothing like institutionalized lack of transparency to warm the heart. Everyone suffers from fear and embarrassment when they commit an act that warrants an apology; just ask any kindergartener. However, when it is well documented that this small act of civility could dramatically improve our healthcare system, you would think that this life lesson would spread more quickly to our nation’s hospitals. For this one, no technology is even required.

While many successful industries can offer lessons in quality improvement that can significantly improve hospital operations, I contend that some of these lessons are quite simple and flow from the well-accepted tenets of decent human behavior. You don’t need a high-priced hospital consultant to tell people to wash their hands or apologize when they hurt someone. Although it turns out you do need one to make sure they actually do it—maybe kindergarten teachers could improve their pay grade by moonlighting on the inpatient floor to counsel physicians and nurses?

There’s one more lesson in the Fulghum poem, and it’s best directed to patients and their families as they walk up to the hospital admissions desk: hold hands and stick together. If you don’t watch out for yourself and your loved ones when being treated in the hospital, there is a good chance that no one else will.

Lisa Suennen is an independent consultant, board member of AngioScore, and a former managing member of the Psilos Group, as well as the co-author of Tech Tonics: Can Passionate Entrepreneurs Heal Healthcare With Technology? and author of the blog Venture Valkyrie. Follow @venturevalkyrie

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