No conversation about healthcare reform would be complete without mentioning patient safety.
You might be surprised to learn that most patient safety problems are rooted in money. In the master list of "never events," published by the National Quality Forum, plus additional problems such as hospital acquired infections, the majority are somehow related to the equation of time and money.
Because reimbursements work the way they do, based on the numbers of patients treated and procedures completed, and not based on the quality of those services, the goal for most doctors and other providers is to see as many patients as they can and complete as many procedures as possible. The results are mistakes and deaths, and depending on whose estimates you believe, those additional injuries total in the millions and deaths total more than 100,000 each year.
Here are some examples of the effects of time and money on patient safety:
Surgical mistakes are often caused by surgeons in a hurry. A system of "time outs" exists to make sure patients stay safe. The system, developed by the Joint Commission, the accreditation body for hospitals, calls for everyone who participates in the surgery to take time for things like marking the site of the surgery, and counting materials and instruments after the procedure. Unfortunately, when the surgical team is in a hurry, these time outs are ignored, and the patient may be harmed.
Among the highest rates of errors are pharmacy errors, either in the hospital or through a neighborhood pharmacy. The problem is that many of the drugs have similar names, and many of the containers look like each other, including similarly colored labels and logos. Lousy doctor handwriting is a well-known problem, too. Pharmacists and their technicians -- in a hurry -- will mistake those similar drugs for each other, or will simply misread a doctor's handwriting. Patients, like elderly persons who may have trouble with their sight, or anyone who just isn't familiar with what drug she is supposed to be taking, may not even realize they have been given the wrong drug. Once again, professionals in a hurry have caused a safety problem.
Among discussions of health care, it would make sense to include considerations about quality of care in addition to accessibility and costs.
Medical Errors and Transparency
Transparency is a word used in many areas of healthcare. It refers to publication of information that will help patients and providers make more informed choices. Reform efforts are underway to help make more medical error information transparent.
When providers make mistakes, whether through misdiagnosis, wrong treatment, wrong prescriptions or others, then we patients need to know about in order to make wise choices ourselves.
When patients can make choices of hospitals based on their infections records, experts believe that hospitals will be more diligent about lowering their infection rates, and patients will benefit.
When the mistakes made by surgeons can be researched by their potential surgical patients, then patients can make wiser choices, and surgeons who make errors will work toward improving their own track records.
Medical error transparency will improve safety. Safer healthcare leads to fewer lawsuits which then means lower healthcare costs overall.
Tort Reform
With all the mistakes being made, it should come as no surprise that there is a corresponding increase in the number of lawsuits being filed. The more lawsuits, no matter whether they are won or lost, the more healthcare costs, too.
Further, the amounts of money being sought in these lawsuits is on the increase. Questions about limiting how much a patient or family can be awarded, called a cap, are part of the discussion. Those questions fall under the umbrella of "tort reform." Should patients be able to sue for damages when an error has occurred? And if so, should there be a limit to the amount they can sue for?
Clearly, patient safety must be considered among the issues in healthcare reform. It's ties to the cost of care are important in the bigger picture.
