Systems Thinking in Healthcare

"If we eliminated medical errors there would be no malpractice. I now believe, through PRHI, that eliminating medical errors is entirely possible. But the work begins with us."

Richard Shannon, MD, Chairman Department of Medicine Shadyside Hospital

Reported in the AARP Bulletin, April 2006.

Righting Wrongs-TheTruth About Medical Malpractice and the Law
By Trudy Lieberman

Ms. Lieberman concludes her discussion of the myths about malpractice with an observation about the notion that "bad doctors cause most malpractice suits." "While a few doctors attract more than their share of lawsuits, they do not account for most of the suits or most of the injuries, say patient safety experts. In 1999 the Institute of Medicine reported that medical mistakes in hospitals cause as many as 98,000 deaths a year, and most are caused by health system failures, not the occasional bad doctor."

She continues, "Many neutral experts who have studied malpractice reform say caps on awards are a Band-Aid on deeper wounds: an inherently unsafe health system, where too many preventable deaths and injuries occur...."

Precisely our point! For over 90% of mistakes it's the system and not the bad apple individual that needs to be improved. We think Dr. Richard Shannon has it right.

Time Magazine's cover story on May 1, 2006 "What Insiders Know About Our Health-Care System that the Rest of Us Need to Learn," concludes:

It's hard to find a doctor who doesn't worry about how medicine is changing, since they suffer at both ends: as providers of health care and as consumers. "What scares me most about the current medical environment is complacency with the status quo," says Martin Palmeri, an internal medicine resident at Dartmouth-Hitchcock Medical Center in New Hampshire. Burgeoning bureaucracies, managed care, the mass production of health-care services and a worsening malpractice climate only strain the doctor-patient relationship. In this environment, the patient, typically a physician's source of inspiration, can become the source of frustration. "When I refer one of my family members to someone," Palmeri says, I want to make sure that they are the type of physician who leaves no stone unturned and will burn the midnight oil if need be to ensure the highest-quality care possible."

What frightens doctors--young ones like Palmeri as well as older ones--is that those doctors may be harder and harder to find. Scientific knowledge improves, but the care doesn't keep up - it is easier to gather gigabytes of information than to acquire the judgment to apply it wisely. It might comfort the rest of us to think what with just a little more knowledge or a personal doctor at our side, we could get the best out of America' extraordinary healthcare system without suffering from its gaps and failures. But since even an insider can suffer, we are left with the much harder challenge: to fix the system for everyone.

Precisely! "Fix the system," the reporters write. But how?

Doctors and their family members, as patients, face the same risks and dangers as the rest of us. Though the reporters leave the reader with a passing reference to "the system," they put the burden of quality squarely on the back of the doctor. That's a tragic misunderstanding of the problem. The doctor can't perform any better than the system will allow. Alone, he hasn't the power to improve. The article misses the fundamental solution: transforming the organization and the processes used to deliver care; namely, the working relationships among doctors, nurses, and other hospital professionals to include real-time problem solving on the job and an understanding of the hospital as a system.