4 Actions to Reduce Medical Errors in U.S. Hospitals -- The Story Behind the Article

I'm happy to share that Dr. John Toussaint and I recently had an article published by the Harvard Business Review:

4 Actions to Reduce Medical Errors in U.S. Hospitals

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How did this call for four actions to dramatically reduce harm in American healthcare come about?

The professional mission at Value Capture and my life’s work is to help American healthcare change dramatically for the better, starting with safety, for the sake of every American and every incredible person who works to deliver or support care.

Dr. Toussaint stands, with few others, as a group of leaders who have both demonstrated through their leadership that dramatically better results are possible. He's also part of a group who have been extraordinary teachers and coaches to the rest of the field, in terms of the way forward.

Periodically, John and I start talking about the current data on harm and quality, the weaknesses and strengths of the current collective effort to improve it, and what next most powerful action steps should we push for. We usually go back and forth across several conversations, sharing data and perspectives -- testing each other’s thinking. The course of our thinking usually evolves for the better. Sometimes we think it could be worth sharing and we approach a publication like HBR.

This time, it wasn’t hard to zero in on the themes in the article.

The devastating scope of harm, poor quality, and profound variation between the best and the worst has not altered fundamentally in two decades of efforts.

The question is why, what’s missing?

Our general leadership framework in healthcare is still weak compared to what is needed to improve at faster rates.

We don’t have a true, powerful national learning system to drive that process with the most powerful strategies, even though we have successful, practical models to follow that come from other dangerous sectors of American life and workplaces.

And we aren’t taking advantage of the emerging power of technology to detect and prevent harm – solutions that can be “plugged in” cheaply and practically and acted upon, today.

Spoiler alert: It turns out it’s the acting that’s the hard part, and that gets us back to leadership …

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The summary reads as follows:

Summary

"Huge numbers of patients are harmed in U.S. hospitals by safety errors. Their numbers could be greatly reduced by taking four actions:

1. Make patient safety a top priority in hospitals’ practices and cultures,
2. Establish a National Patient Safety Board,
3. Create a national patient and staff reporting mechanism, and
4. Turn on EHRs machine learning systems that can alert staff to risky conditions."

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