Hospitals need to be held accountable for mistakes

Hospitals need to be held accountable for mistakes

July 7, 2001

Honesty is welcome, but openness is needed as well.

Under a rule that went into effect Sunday, the Joint Commission on Accreditation of Healthcare Organizations requires hospitals to tell patients when they have been the victims of medical errors. It is a welcome step, but when it comes to making our health-care system open and accountable, it is only a start.

’Fessing up to the victim or the next of kin is a moral obligation. Honesty within the medical profession about mistakes is an analytical necessity. As a matter of public policy, however, the public also needs to know.

The commission is a nonprofit group that monitors the performance of almost 5,000 hospitals nationwide, including Southwest Memorial in Cortez, and Durango’s Mercy Medical Center.

Mercy and Southwest Memorial already inform patients of medical errors as a matter of policy. So do Veterans Affairs facilities. The ethical canons of the American Medical Association and the American Hospital Association require it as well.

That the commission felt it necessary to issue a rule on the subject, however, suggests that not every hospital has lived up to that ideal.

Moreover, while JCAHO says patients must be told when a medical blunder causes them harm, it does not require the hospital to report the incident to the commission, or to anyone else. Some state reporting may apply in serious cases, but at best that lacks the perspective of data gathered nationwide.

The commission’s president, Dr. Dennis O’Leary, says "We need to create a culture of safety in hospitals. . . in which errors are openly discussed and studied so that solutions can be found and put in place." What he means is a culture in which doctors, nurses, administrators and support staff feel safe reporting mistakes.

It is part of an approach developed in areas like nuclear power and aviation where a problem can produce catastrophic results. The idea is to analyze the complete system for points where human error poses a risk. A mistake reveals where more work is needed. Concealing one perpetuates the problem.

Developing that "climate of safety" is an admirable goal, but it should not be seen as an alternative to public accountability. Medical mistakes should also be reported and aggregate data for each hospital made public.

We do not need to invade patients’ privacy or second-guess doctors. We do, however, have a right to know how our safety may be affected by how our hospitals are run.