EHR should assist us with evaluating quality metrics.
If I could design the ultimate EHR, I would design one
that interfaces with all records and provides appropriate benchmarks with good quality metrics.
So, why don’t we have this type of EHR yet?
It’s expensive. But we need the government to step in
and mandate that these changes be made. We need to
make sure that our EHRs are a part of an integrated
system that talks to everyone and provides the data
Is poor leadership the reason behind our fail-
ure to improve patient safety? Should hospital
executives be trained similarly to those in other
It is important to understand failure of leadership
when attempting to understand failure of maintaining safety, so yes, all hospital executives should be
well versed in patient safety initiatives and undergo
the same training as the staff undergoes. But remember, health care is far more complex than most other
industries so the training should not be the same as
in other industries.
One of my colleagues asked me why the payment
models appear to reward CEOs and insurance
companies in manners that are not aligned with
patient safety and culture. Do you think that if
CEOs were penalized for every adverse event at
their hospital it would promote culture change?
I think that health care workers know that CEOs make
money inconsistent with others in health care. Their
compensation should be affected by or linked to patient
Hippocrates said, “first, do no harm,” but is that
the same as “zero patient harm”? Does a focus on
zero harm help or hinder our cause in improving
safety in health care?
I do not disapprove in general of the notion that we
should have zero harm, but only when referring to
never events. Everyone needs to remember that this
environment is simply too complex to avoid any harm,
but there is nothing wrong with this concept as a global
mission. We just have to remember we cannot avoid all
complications. However, we should never have never
events—wrong site, wrong side, wrong patient, and
so on. We simply cannot allow that to happen to our
How do you and your department encourage a
safety culture at your institution?
The culture of safety is discussed vigorously at every
M & M [morbidity and mortality] conference, at every
patient’s bedside, in all discussions about patients, on
daily rounds, with the intent that no one forgets that
patient safety is always our goal.
Why do we, as a surgical community, consistently
argue about the validity of the data rather than
acknowledge that a problem exists, move on, and
seek solutions that work in departments?
We have not told the story very well. Surgeons must
remember that the safety environment was brought
about by surgeons. We created that safety culture long
ago. Surgeons have handed that responsibility to others
and need to go back to those principles. We all need to
realize that being an outlier has consequences. Everyone knows there are three principles surgeons must live
by. Clinical excellence and strong education are the first
two. The third is good stewardship of resources, which
includes effective utilization of resources in order to
enhance quality care and patient safety. ♦
Surgeons must remember that the safety environment was
brought about by surgeons.... Surgeons have handed that
responsibility to others and need to go back to those principles.