Health
Queen's stresses importance of admitting medical errors

By Alice Keesing
Advertiser Health Writer

Officials at The Queen's Medical Center want to break the "code of silence" that permeates Hawai'i hospitals, resulting in medical mistakes that can injure or kill patients.

The mistakes are often the result of communication or procedural glitches: the pharmacist who can't read a doctor's writing, the test result wrongly filed, the confusion in the operating room over the patient's left and right side.

Staff people are afraid to admit such errors for fear of retribution, dismissal, humiliation or lawsuits. But by covering them up, hospitals do nothing to fix the underlying problems.

"It's not something that's going to be a quick fix," said Dr. Della Lin, executive director of Queen's continuing medical education. "It's saying, 'Yes, we all can do better,' and instead of hiding behind errors, we have to open up and talk about it."

Queen's said it is seeking a "renaissance" in how it communicates and does business, and held a conference Saturday aimed at pushing the process forward.

It's part of a nationwide renewed emphasis on patient safety sparked by an Institute of Medicine report two years ago, which estimated that medical errors kill as many as 98,000 hospitalized Americans a year. There are no figures for Hawai'i, but the state is not immune.

Experts say most errors — 90 percent or more — are the result of flaws in procedures or policy rather than a doctor's or nurse's mistake. And that means the problem can be fixed.

"We're taking this issue very seriously," said Rich Meiers, president of the Healthcare Association of Hawai'i, which represents all the state hospitals, as well as most nursing homes, hospice and home-care providers. "All of our facilities — and not just hospitals but our nursing homes, our home help agencies — are in on this."

The association is heading up a task force that began meeting in August to identify problems in patient safety in Hawai'i. Other hospitals are moving on the issue; St. Francis Medical Center held its own patient safety conference in October.

To learn, the healthcare industry is taking many of its cues from the aviation industry, which already has gone through its own growing pains in improving passenger safety.

Like the airline industry before it, the healthcare business must rid itself of the "blame culture," according to John Nance, a founding board member of the National Patient Safety Foundation at the American Medical Association. Nance, who also is an internationally recognized air safety analyst, was a keynote speaker at the Queen's conference.

"We have a system now that has all these tremendous penalties," he said. "In this blame culture, you're more focused on who you're going to fire, who you're going to suspend, who you're going to sanction rather than fixing the system."

Meiers said the healthcare business is looking at a reporting system used by the airline industry that allows employees to report their errors without fear of retribution.

"We're trying to develop a policy where, if somebody realizes a mistake has been made, they can come forward with it right away, they talk about it and they can do it without fear of punishment," he said.

Nancy McGuckin, executive director of the Hawai'i Nursing Association, and others say hospitals should be looking at their own cost-cutting as a source of unsafe care.

"I have grave concerns," said Arlene Meyers, president of the Hawai'i Coalition for Health and a practicing pediatrician. "I have noticed an erosion of quality of care in hospitals, and I believe the most important issue is because hospitals are having financial difficulty and are needing to engage in all kinds of cost-cutting activities. They have absolutely reduced the number of their well-qualified nursing staff."

Meyers lays the blame for the decline in care at the door of the managed-care system. The hospitals themselves point to federal laws that have cut their incomes by slashing reimbursements. With shrinking budgets, hospitals have had to cut back on programs and staffing, raising concerns about patient safety.

Hawai'i nurses nearly walked the picket line two years ago over hospital plans to use untrained people to do nurses' work. The resulting contract with the state's biggest hospitals froze nurse-patient ratios, but McGuckin said nurses still must take care of more patients in less time and with fewer resources.

"I think they really need to be looking at getting the knowledgeable eyes and hands back to where they need to be and giving their professional staff enough time to make some good judgements," she said. "You can have all the medication systems that you want, but you still need an R.N. who can identify when a patient may or may not fall out of bed or be able to make good judgements on whether or not the physician made the appropriate medication order."

Meiers agrees the hospitals' money problems compound the issue of patient safety.

"You have to do the best you can, and as you run out of money, that's when you cut services like every hospital has done within the past year; that's when you cut people in order to survive," he said. "Obviously, the first thing you never want to compromise is patient safety. Once you do that, you lose your credibility, and dedicated health care professionals just aren't going to do that."

Reach Alice Keesing at akeesing@honoluluadvertiser.com or 525-8014.