Hospital Administrators Need to Put Patient Safety Above Profits, Health Expert Argues

December 2, 2019

In Health Affairs this morning, Michael L. Millenson waxes passionately about the flaws of a healthcare system in which preventable hospital harms still too often occur. And he takes hospital administrators to task by asking if their institutions actually profit when mistakes, such as central-line-associated bloodstream infections, happen. “Do we believe in ‘First, do no harm’? or ‘First, do no unprofitable harm,’ even if it means blurring the moral boundary between filling hospital beds with those we’re trying to help and those who we have just hurt?” he asks.

Millenson, an internationally recognized expert on patient safety, notes that we near the 20th anniversary of the landmark Institute of Medicine study To Err Is Human and, although some improvement seems to have occurred—for instance, every hospital in the country is doing something to reduce preventable harms—he nonetheless loads his opinion piece with links to studies that still tell a somewhat disheartening tale. You can check them out herehereherehere, and here.  

Millenson isn’t blaming hospital administrators, per se, but says that too often it is easier for infection control to become a somewhat routine and dangerously dysfunctional effort. Providers don’t escape blame, either. 

Millenson: “As a study of clinician overconfidence in infection control delicately concluded, providers ‘do not recognize the need for training [for themselves] but express this need for others.’ In that context, we perhaps should not be surprised that 40% of respondents to a recent nationwide survey’ on hospital safety culture agreed that ‘hospital management seems interested in patient safety only after an adverse event happens.’” 

Millenson acknowledges some push-back, noting that the Society for Healthcare Epidemiology of America in 2007 made the case that its members didn’t just add to costs but that there’s a genuine “business case for infection control. A dozen years later, infection control specialists still feel they need ‘an administrative champion,’” Millenson writes.