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Priorities: Put patient safety before profits

September 11th, 2012

by John J. Nance

On Jan. 15, 2009, had Captain Sully Sullenberger and First Office Jeff Skiles spent as little as 15 seconds discussing the financial advantages of trying to land an engineless jetliner on a runway versus setting it down in the waters of the Hudson River, we would have lost them. All of them.

The passengers and crew alike would have perished in the 150-knot impact of a metallic eggshell (read:jetliner) with blocks of brick houses up to a mile short of the runway at New Jersey's Teterboro airport, which was where the pilots desperately wanted to go.

That, of course, is hindsight. But in the throes of the emergency--with only 15 seconds to make a decision--what criteria should be used?

[More:]

If finances were paramount, then saving the 60 million-dollar Airbus A-320 at all costs would have driven their thinking, and that would have meant gambling there was enough altitude and airspeed (stored energy) left to glide to safety.

If, however, the welfare of everyone aboard was the prime consideration, then the safest choice was ditching in the endless watery runway right below them ... the Hudson River ... the move that held the highest likelihood of success.

Fortunately, they decided to go for the sure thing. They could make the water. The runway was a gamble.

While it's more of a slow-motion version, a staggering number of American hospitals are in the throes of almost precisely the same category of emergency: How do we react when we lose the engines of traditional hospital financing?

Do we concentrate on the money, and chase profitability blindly on the theory that the 30 people we kill on average every hour (from medical mistake and nosocomial infection) are less important than keeping the doors open? Or do we first concentrate on doing what's best for our patients, even if it means teetering on the brink financially?

Should we, in other words, frantically spend the institution's gold on hiring doctors directly, contracting with massive physician practice groups or trying to achieve sustainability by purchasing or merging with other hospitals and practices because even having a partially-safe institution stay open is better than having none at all?

Are we justified in temporarily shoving aside our previous focus on reaching zero harm to pump up the HCAHPS scores, spending time trying to make the dietary department a four-star restaurant while we pretty up the rooms and the greetings and ignore the wrong-site surgeries and MRSA infections that keep occurring?

Or do we focus clearly and immediately on the stated ethic--the mission--of any hospital, and act accordingly, even if the dollars are poorly served?

There is a word to describe this process of shoving aside the things that truly count to divert all the organizational intellect to producing immediate dollars. It's called "panic," and it's increasingly gripping the C-suites and boards of American healthcare, driving otherwise concerned people to look the other way while patient safety initiatives are shelved to make way for emergency survival profitability.

After all, sustainable programs to markedly improve communications among staff members, instill true collegial interactive teamwork in all critical areas, end medical apartheid (docs over here, everyone else over there), and adopt evidence-based best practices and a single standard of conduct for all cost time and money.

Yes, the US Airways example is just aviation, but the lessons are the same. When the engines stop, it's the leaders with perspective and perseverance--not those who panic--who stay afloat.

John J. Nance, J.D., is an internationally-published author, professional speaker and national broadcaster. He also is a founding board member of the National Patient Safety Foundation and co-author with Kathleen Bartholomew of "Charting the Course: Launching Patient Centric Healthcare."

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