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How hierarchy in hospitals causes medical errors

medmalnurses4.jpgThe findings of an international study show that nurses and support staff are sometimes hesitant to voice their concerns when they see something wrong during surgery, resulting in surgical errors that cause serious injury and death. This has prompted a team of Australian researchers to develop and test ways to improve communication among members of surgical teams.

According to an Australian news report, adverse events occur in 22 percent of all surgeries, with half of those found to be very preventable. Surgeons are usually at the top of a hospital hierarchy, making it difficult for staff members to suggest that a surgeon might have made a mistake. This is often true in the United States as well.

A U.S. study, reported in ProPublica in 2013, stated that 21 percent of hospitalizations resulted in medical mistakes, with 1.4 percent of those errors directly causing the death of the patient. A New York Times story, also in 2013, echoed those findings, stating that breaking with traditional hospital protocols sometimes provokes significant abuse. In some instances, nurses are retaliated against for questioning a doctor or surgeon. Nurses are even blamed for mistakes made by doctors. A New York Times blog writer noted, also in 2013, that medical mistakes kill 100,00 people each year in the U.S.

There are other estimates of the number of medical errors and deaths caused by medical mistakes. Medical records are sometimes surprisingly imprecise. Moreover, institutions sometimes try to hide medical errors, glossing over deaths in an effort to improve their rankings and avoid liability. The lack of firm information about the number of deaths caused by medical error also makes it hard to develop ways to correct the problem. If some of the players involved refuse to acknowledge the extent of the problem, it is difficult to devise a solution.

Like U.S. hospitals, Australian hospitals have an extremely hierarchical atmosphere that sometimes prevents staff members lower in the hierarchy from speaking up when they see something going wrong. One of the proposed improvements that will be tested in the Australian pilot study is a five-minute presurgery meeting of all involved staff as a way to improve communication among members of surgical teams.

According to a recent article in the Huffington Post, hospital errors in the United States are down from 2010 levels. One theory is that the Affordable Care Act reduces payments to hospitals with higher rates of hospital-acquired infections, giving the facilities financial incentives to make improvements in processes and procedures, improvements that save lives.

This is a great first step toward improving patient safety in hospitals. But until surgeons and physicians in hospitals and other settings let go of some of their position and acknowledge the possibility that they might make errors, patient safety in hospitals and other care settings will continue to improve only slowly.

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