Thursday, June 26, 2008

Infection control, patient safety and a culture of blame

Health care facility related infections have a history of being measured. Recently, certain ones have been shown to be largely preventable. Ergo, when an event occurs it’s an “error” and somebody’s to blame. Therein lie unintended consequences. Those consequences will be magnified come October when Medicare’s no pay policy kicks in.

Bob Wachter recently blogged about infection control’s increasing importance in patient safety. He noted:

Branding a healthcare-associated infection a “preventable adverse event” meant that failure to adhere to the practices that could decrease the rates of these events could be deemed “medical errors.” Ergo, the failure by a healthcare provider to clean his or her hands wasn’t simply an annoyance to infection control professionals… it was A MEDICAL ERROR!

There is a distinction between defining a process breach (failure of hand washing) and a bad outcome as an error. While it could be reasonably argued that failure to wash one’s hands before patient contact is an error it’s quite another thing to label every catheter related infection or episode of ventilator associated pneumonia as error. Wachter seems to make the distinction but a commenter said this:

Hospital derived infections are often physician errors and to align incentives and protect patients it may be worth considering that the physicians be responsible also financially for their patients' infections this may be draconian but necessary.

With a possible move in the offing to bundle physician fees with hospital DRG payments, it could happen. Why not?

The patient safety movement was supposed to move us away from a punitive culture of blame. That, we were told, would promote the transparency and openness necessary for us to confront the system issues important for patient safety. Ironically, our efforts seem to have had the opposite effect.

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