Of all the ways to improve the dismal state of patient safety in U.S. hospitals (some of which we've covered, like here), by far the stupidest approach is the one that focuses on removing doctors’ “fear of litigation.” The theory is that if a negligent doctor doesn’t fear being sued when a patient is injured or killed, he or she will be happy to blab about everything they did wrong. And then as soon as the hospital hears what went wrong – voila! – they will take steps to make sure these “never should have happened” events never never happen again. Well, maybe in you’re livin’ in Never Never Land, USA.
And by the way, how convenient for insurers, organized medicine and their lobbyists to define the problem that way, because then there’s only one solution – limiting litigation. Whether that means capping damages for injured patients (talk about a failed policy) or “apology” and early compensation programs (which can be equally problematic), injured or dead patients are somehow blamed and as a result, their rights are limited or stripped away altogether.
Meanwhile, this approach does nothing whatsoever to improve patient safety and probably makes it worse. And this is notwithstanding the fact that we know that “fear of litigation” is not why doctors fail to report errors, and a state can enact as many “tort reforms” as they want and they will still have no impact on doctors’ behavior.
Well finally, we’ve got some empirical muscle behind our little theory. The New York Times reports today on a new study from the U.S. Department of Health and Human Services, and their findings are striking:
Hospital employees recognize and report only one out of seven errors, accidents and other events that harm Medicare patients while they are hospitalized, federal investigators say in a new report.
Yet even after hospitals investigate preventable injuries and infections that have been reported, they rarely change their practices to prevent repetition of the “adverse events,” according to the study.
And get this: the massive error “underreporting” problem at hospitals has nothing to do with “fear.” Rather, it’s because hospitals employees don’t seem to know what patient harm even is – and if they do, they think it’s someone else’s job to report it. Says HHS,
[T]he problem is that hospital employees do not recognize “what constitutes patient harm” or do not realize that particular events harmed patients and should be reported.
In some cases … employees assumed someone else would report the episode, or they thought it was so common that it did not need to be reported, or “suspected that the events were isolated incidents unlikely to recur.”
The Times also notes,
The Obama administration and hospital industry leaders have placed a high priority on reducing medical errors. But, the report said, at many hospitals, this high-level commitment has not been translated into practice.
The inspector general found that “hospitals made few changes to policies or practices” after employees reported harm to patients. In many cases, hospital executives told federal investigators that the events did not reveal any “systemic quality problems.”
I mean, could it be more clear? Hospitals already know perfectly well how stop errors that should never never happen. They are simply not doing it - and it’s time to stop blaming patients.
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