Wednesday, August 26, 2009

Hospital Errors

In yesterday's Wall Street Journal, Laura Landro has an excellent column titled "Hospitals Own Up to Errors." She explains how many hospitals have begun to acknowledge their medical errors more openly, rather than "retreating behind a wall of silence to guard against potential lawsuits." Hospitals not only have encouraged their staff members to be more open about mistakes, but they have become more candid with patients and families as well. Amy Edmondson, Anita Tucker, and I wrote a case study several years ago about one hospital's efforts to improve patient safety by becoming more transparent about medical accidents. We wrote about Children's Hospital and Clinics in Minneapolis/St. Paul. At the time, their Chief Operating Officer, Julie Morath, was leading a major initiative to improve patient safety. She strove to create an environment where people felt safe coming forward about medical accidents and near-misses, on the theory that a hospital cannot improve safety if it doesn't know where the problems are. The lesson here is very clear... Organizations must create an environment where individuals feel safe acknowledging mistakes and discussing failures. If not, then the published error rates may seem low, but they may be disguising an ugly truth, while preventing the organization from discovering where improvement opportunities exist.

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