True patient safety cannot be regulated

In an effort to promote transparency in healthcare, the Association of Health Care Journalists (AHCJ) has published a database of recent hospital deficiencies discovered by Medicare and Medicaid  inspectors. They then highlighted 168 reports containing the phrase “immediate jeopardy.” This, of course, piqued my interest as I presumed that hospitals who were putting putting patients in “immediate jeopardy” must be some pretty bad actors.

After sifting through the hospital names, I saw no record of ones who should probably be on the list based on my personal experiences. I did find some surprises, including well respected academic centers (including Stanford, UCSD, and Intermountain Healthcare). I did a “deep dive” on a hospital for which I have a good deal of respect and some familiarity. What I discovered was both funny and sad.

In the case of the hospital that I knew, the very grave concerns expressed by the inspectors turned out to revolve around patient signatures on HIPAA documentation, and physicians refreshing their electronic restraint orders on patients with traumatic brain injuries. These documentation mishaps had landed the hospital on the ominous list of institutions who are “putting patients lives in immediate jeopardy.”

What a waste of inspector time and hospital resources! Apparently, a hospital who passes CMS muster simply means that they are providing documentation correctness to patients. Forget the real sources of life-threatening dangers — medication errors, poor physician handoffs, unnecessary testing and treatment, and unsanitary conditions. What the safety police are focused upon is whether or not the sick and delirious signed their health information privacy paperwork.

Now don’t get me wrong, I think it’s important to let patients know their rights. But I’ve yet to see more than 10% of patients even read the HIPAA-related documentation that they sign.  Surely an absent signature or two shouldn’t land a hospital on a humiliating federal watch list.

True patient safety cannot be regulated. It is far too complex and nuanced, requiring collaboration between all members of a hospital’s staff. From frequent nursing surveillance, to careful medication review, to laboratory critical value alerts, to conscientious sanitation practices – hospital culture dictates whether or not a patient receives excellent care. Watch lists would be far more accurate if they were simply based on hospital employee questionnaires. As Dr. Marty Makary has discovered, complicated care quality algorithms are no more accurate at predicting hospital excellence than simply asking staff if they’d recommend the place to family members.

So next time you see your hospital flagged by the feds, don’t assume that there is a serious problem going on — better to ask someone who works there if it’s a safe place for care.

Val Jones is founder and CEO, Better Health.

Comments are moderated before they are published. Please read the comment policy.

  • SteveCaley

    In societies controlled by terror, there is no need to verify the accusations before springing into action. Of course, they are guilty – if not of this, then something we missed!
    The culture of the View – The Gaze, or of being watched by the All-Seeing Eye – chills us as much as any sense of actual guilt.
    And we have reinvented the Culture of the Watchers. They can see, judge and sentence in one gasp! HIPAA signature sequencing is an observation -