It took forever, but the government has announced that Medicare will no longer pay for hospital-caused diseases. The policy will cover hospital-caused injuries, preventable errors and infections.
The Center for Disease Control estimates that hospital-caused infections alone result in 270 deaths a day, or nearly 100,000 deaths per year. In addition more than a million and a half patients needlessly contract hospital, or nosocomial, infections who do not die but do suffer, and often grievously. We’ll leave it to your imagination to calculate how many billions of dollars so much gratuitous illness costs.
Announcing a new policy may or may not lead to effective action. The hospital industry, which has fought tooth and claw for a generation to prevent statistics on hospitals’ success rates, can be counted on to do its best to sabotage carrying out the policy. On that topic The New York Times reported: “Dr. Kenneth W. Kizer, an expert on patient safety who was the top health official at the Department of Veterans Affairs from 1994 to 1999, said: ‘I applaud the intent of the new Medicare rules, but I worry that hospitals will figure out ways to get around them. The new policy should be part of a larger initiative to require the reporting of health care events that everyone agrees should never happen. Any such effort must include a mechanism to make sure hospitals comply.’”
In making this policy change Medicare is not reacting to a recently discovered scandal in the health care system. Widespread indifference to their patients’ welfare has been a fact of life in American medicine for many years. Harvard’s Dr. Lucian Leape, one physician who has not been indifferent, writes: “Since our Institute of Medicine committee issued the report ‘To Err is Human’ eight years ago, patient safety leaders have been calling on hospitals to get serious about safety, to make a commitment to eliminating preventable injuries, and to implement known safe practices that will prevent them. Some have. Most have not. It was as if the safety folks were speaking a foreign language. Now the hospitals are being spoken to by people with authority and in a language they understand: the language of money.”
Dr. Leape, who is a major figure in the field of patient safety, goes on to say: “Hospitals have had the opportunity for some time to help their patients and save money by implementing a number of proven safe practices—bar coding of medications, computerized ordering, prevention of blood stream and ventilator-associated infections, to name a few—and most have ducked it. The ‘business case’ for safety has been well-established. Now it is the payers, not the hospitals, who will save the money—and, if we’re lucky, the public—in the unlikely event that savings get passed on in reduced premiums.”
Doctors such as Lucian Leape have invented a number of step-by-step procedures or protocols to prevent infection and injury. These must be undeviatingly adhered to by hospital staffs, and if they are, gratuitous infections are significantly reduced.
It is a time-tested formula used in many organizations to overcome the damage done by lazy, indifferent and hostile employees. Strict protocols backed up by computerized record-keeping will lessen, though not end, hospital staff administering the wrong medication to patients or the wrong dosage at the wrong time. It is the battle of strict procedures against the sabotage of slovenly workers.
The protocol approach works fairly well, though it does not address the problem of lazy, indifferent and hostile employees—the people in the health care field who are not guided by the ethic of medicine, who do not put the patient first. These are the people who will leave patients in pain, vomit and agony if it’s lunchtime.
American hospitals were not always germ motels. If you go back a certain number of decades, the dirty floors vanish, as do the soiled sheets left on patients’ beds. That is back in the white era, the era when doctors wore white, as did nurses and attendants; the bed linen was white as well. The disadvantage of white was that it showed the dirt so immediately and so blatantly. Today’s hospital blues and greens do not soil quite so fast or offensively.
The undermotivated include doctors, dentists and nurses who know better but do not wash their hands before they put on sterile gloves and touch a patient. It is amazing, but they do it with the full knowledge that their negligence may kill the person whom they are treating. As you travel down the hospital hierarchy, undermotivation becomes more prevalent, not that it is not bad at the top.