I received this intriguing comment:
You are admirably in favor of evidenced based medicine. I read through Wachter's post looking for any evidence that all of this frenzied activity actually does any verifiable good. They meet, they discuss, they come to a shared understanding. They function more effectively as a committee. Absent is any hard data that indicate that bad stuff happens less now than it did back then. There is no question that they are spending a lot of time that otherwise would be available to fulfill the core mission of the institution (patient care). They also believe that it makes the front-line caregivers more appreciative of the efforts of their administrators. Clearly they have never spent any time on a patient care ward nursing station- all they ever talk about is how warm-and-fuzzy they feel about their administrators.
This would be worth it if there were evidence, numbers that indicate that bad things happen less often. But there is no evidence. Just the warm self-congratulatory feelings that come from an administrator convening yet another meeting. It just has to work, right?
This comment does surprise me. This thoughtful commenter makes several assumptions that I cannot accept.
This comment uses a technique that I have used – the lack of evidence that root cause analyses make a positive impact on safety. I admire this straw man construction, but I disagree.
We are still in the early stages of the safety movement. I do not believe you can deny the problems that these committees review. Careful root cause analysis identifies fundamental flaws in hospital operation. Many of the analyses find that communication errors are to blame, but the array of problems is extensive.
These safety committees are defining the problems so that we can learn to avoid these serious errors. These committees are diagnostic committees. We would have a difficult time proving that we have decreased diagnostic errors, but we all believe that improving diagnosis leads to improving medical care. Likewise, I believe that improving the diagnosis serious safety errors will lead to future prevention of many errors.
I cannot cite chapter and verse, but I do believe that there are some examples of improved safety and decreased patient harm. Perhaps some readers can provide that proof.
But even if I could not assert improved safety, I do not understand the objection to physicians, nurses and administrators learning about safety errors. At our institution, practicing physicians and nurses meet to learn from each other.
So I thank the commenter, but must respectfully disagree with the argument. I stand firmly in favor of ongoing exploration of hospital safety.
{ 2 comments… read them below or add one }
Thanks for your comments.
You are a better writer than I, so it's not surprising that my point was not made, as the man says, completely clear. I did not intent to claim that Dr. Wachter's Weekly Wednesday Exercise is completely without merit- that would be a straw man argument. I do not deny the problems that these committees review. I agree that defining the problems is essential, and I completely agree that without proper diagnosis, we have no chance of curing the patient, or preventing recurrences.
Where we differ is in the conclusions that we draw from the WWE. I may be misreading you, but you seem to accept the concept that the WWE is such a good idea that it just simply has to work. Just as the 80 hour workweek simply has to lead to fewer mistakes by house staff, or that the pre-op time-out simply has to improve intraoperative outcomes, having a meeting with all the honchos and doing it just so simply has to improve care. All I ask is for some proof, or at least some evidence, that this is so. Beliefs and feelings are nice to have, and nobody will object to everyone learning about safety errors, but when you are consuming such vast resources in money and time, I want at least some evidence. What kind of evidence? We now have a government provided list of "Never" events (I'll leave a discussion of that ludicrous concept to another time). Have we come closer to "Never?" or, rather, has Dr Wachter's hospital come closer to "Never" than another hospital that does everything else the same but does not do the WWE? It should be easy to find out- "Never" events are by definition reported. If you agree that the "Never" event concept is ludicrous, please provide some other indicator or proxy for quality.
I'm not trying to be snarky here- I really would love to see a means of definitively improving the quality of our product. Just as with the 80 hour workweek or the pre-op time-out, data are lacking that overall any of this has done any good, and unintended consequences are the rule in these situations. Until there are data, even if anecdotal, spending several thousand dollars per week and taking key personnel away from core mission activity is too high a price to pay for a feel-good exercise.
This may be the early stage of the safety movement (although it has been going on for ten years) but the tools in use come from the reliability world where they have been used for over 40 years. Tools such as FRACAS (Failure Reporting And Corrective Action System) and Reliability Growth Management provide a system not only to discuss solutions for root causes but provide measurements of the progress made (or lack thereof) in error reduction.
One of the problems is that well meaning physicians start applying these tools without adequate training in their use.
Along these lines, there was an earlier Wachter post which complained about too much incident reporting. This is not right as I commented, and on my own site.