U.S. hospitals: A struggle for safety

To the editor:

The U.S. is a world leader in biomedical research and the development of medical technologies. In this we excel. However, the data on U.S. population health, and the functionality of our healthcare system, does not stack up well against other countries of comparable Gross Domestic Product. We are dead last — at the bottom of 17 nations — according to the Institute of Medicine report ‘U.S. Health in International Perspective: Shorter Lives, Poorer Health’.

In attempting to raise awareness of the data on patient safety and quality it is not my intention to deride healthcare organizations or health professionals. I am supporting research with clinicians in high-technology/high acuity critical care settings who must engage in herculean efforts to overcome the limitations and failures of their information systems, supply shortages, arcane process requirements, and unmet maintenance needs (to name a few issues). Imagine being a bedside nurse in a pediatric cardiac intensive care unit and having to run to a pharmacy on another floor for urgently needed, life-saving medication because the medication dispensing unit in the child’s room has a broken biometric lock, despite a month of urgent maintenance requests. This is one manifestation of a wide array of managerial problems in healthcare that can – and do – contribute to preventable patient injury and death.

The quality and safety issues are not about our healthcare system’s technical capability, nor the expertise, skill, and intentions of health professionals. The overarching problem is that our healthcare delivery system, and especially hospitals, remain lodged in a pre-industrial organizational form that is incapable of reliably managing complex, high-risk technologies and processes. Patients and health professionals deserve better, and the Patient Protection and Affordable Care Act establishes performance incentives that are a step in the right direction.

Jeff Brown


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