Wednesday, November 05, 2008

How Open Should Hospitals Be About Errors?

An interesting attempt by the CEO of Beth Israel Deaconess Hospital in Boston to be more open about the errors that occur in his facility (via KevinMD). Openness about hospital errors has its price though:
For the past year, Paul Levy, president of Beth Israel Deaconess Medical Center, has more than ever before staked his reputation on "transparency," particularly about medical errors inside his Harvard teaching hospital. 
In January, he made a splash when he announced the hospital would aim to eliminate all preventable harm to patients within four years and would publish quarterly reports on its progress. Whether speaking from a podium or writing on his blog, Levy maintains that admitting and learning from serious mistakes is far more important than avoiding public-relations blows. 
This stance has won him praise in some quarters - and, in recent months, has sorely tested him as well. 
In late June, news broke that a cosmetic surgeon was fired after he appeared to be dozing while performing a liposuction procedure. A few days later, a veteran surgeon completed surgery on a woman's ankle - only to discover it was the wrong ankle. 
Earlier this month, an anesthesiologist, who had battled drug addiction and been terminated a year earlier, was found dead in a hospital closet, a possible suicide. And just last week, a 37-year-old Medford woman died during an emergency caesarean section at the hospital; her baby has survived. 
Other controversies have erupted under Levy's leadership this year as well, including a management shake-up in the surgery department, complaints of overworked surgery residents, and bitter volleys between Levy and a national union trying to organize the hospital's workers. The union chronicles a range of complaints on a website called "Eye on BI" and on bus shelter advertisements, and accuses Levy of promoting "corporate-style medicine." 
Yet sitting in his office last week, the 58-year-old chief executive officer displayed an upbeat attitude, saying he refuses to let the publicity about these issues rattle his mission to make his 621-bed hospital, which performs about 9,000 surgeries a year, one of the most aggressive in confronting problems.
While the efforts deserve to be applauded, I think there is a risk that such errors will be sensationalized to the detriment of the hospital. As the article notes, without putting the error rate in context (ie, with a comparison to the error rates at other hospitals), the CEO is putting the hospital at risk of garnering a negative public impression, even though the hospital is likely outperforming its peers. Still, I guess someone has to lead the way, so kudos to BID.

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