What Do You Want From Your Hospital?*

I've come to the sad conclusion recently that the penultimate US cultural paradox is the "Health"(broadly defined) of US Hospitals and as a subset the health of US health care workers within all strata. In short, the 5000 or so US hospitals are in deep trouble- very deep trouble. They have lost their way and may not be able to find their way back unless they are radically transformed in my opinion.

What evidence do I have to make such a sweeping pessimistic statement? To begin let us start with the fundamental issue of how safe hospitals are? (Seems a rather odd question to pose for institutions whose fundamental purpose is to cure or heal the sick or restore the injured?). But since the release of the landmark NIH report "To Err Is Human: Building a Safer Health System (2000)Institute of Medicine (IOM) on medical errors stating that then medical errors were the 8th leading cause of death in the US in my opinion not much has changed? Although there are a few rays of hope in Institute of Medicine. Preventing Medication Errors. Washington DC: National Academy Press; 2007.

Furthermore some estimate that medication errors are the 4th leading cause of death in the US. Hospital Acquired Infections (HAIs) have alarmingly rise in recent years and now number anywhere from 5-10% of the @35 million Americans admitted to the hospital each year. (see Emerging Infectius Diseases, Vol. 7, No.2, March -April 2001)Violence and crime have increased in hospitals recently especially in emergency room settings in inner city intitutions where paradoxically some of our greatest teaching hospitals reside.

Hospital billing systems are broken with with estimates by some that a whopping 95% of hospital bills having one or more errors. Many hospital Health Information Technology systems, (HITs)while holding great promise, have been poorly implemented leading to negative consequences. http://jama.ama-assn.org/cgi/content/abstract/293/10/1197

Many hospitals are in severe financial crisis and may go the route of bankruptcies not unlike the US Airline Industry (see Health Affairs Vol 25, No 1- Jan/Feb 2006- "Could US Hospitals Go The Way of U.S. Airlines" by Stuart H. Altman, David Shactman, and Efrat Eilat from Brandeis University.)


Perhaps at the core of why hospitals are broken so badly are three critical issues

- Hospitals (even so called non-profits) are driven almost exclusively by a market driven business model which has abysmally failed

- Hospitals cannot plan because they have no planning roadmap given their justifiable requirement to operate under seemingly everchanging government driven oversight, legislation and regulations

- Hospitals have deified technology to an extreme irrational and costly degree. They have grossly failed to recognize that while their patient/customers want good technology- that patients also want and deserve that their social, psychological and spiritual needs be addressed/met. In short technology is good but simply incomplete. I call it the need for "Bio-Medicine Plus"

Technology "bites back" when overused says Edward Tenner from Princeton. Why Things Bite Back: Technology and the Revenge of Unintended Consequences (Vintage) by Edward Tenner And Diana Dutton believes in many cases our medical interventions are "Worse than the Disease": Pitfalls of Medical Progress" by Diana Barbara Dutton. Drs. Elliot Fischer and Gilbert Welch of the White River, VT.,VA hospital published a most compelling and convincing paper in JAMA entitled "Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse?"( SPECIAL COMMUNICATIONS:Elliott S. Fisher; H. Gilbert Welch-JAMA, Feb 1999; 281: 446-453)

On the brighter side:

- Lives are saved every single day in our nation's hospitals

- Election Day November 2006 Was a Good Day for Health Care? says Karen Davis -President and CEO of The Commonwealth Fund http://www.cmwf.org/aboutus/aboutus_show.htm?doc_id=422964

- Innonvative hospital leaders like those in The Planetree Hospital Movement are not giving up http://www.emediawire.com/releases/2006/11/emw474587.htm

- Western history and other cultures have much too teach us.

My personal take on hospitals as a 61 y/o doctor. Well, in the 1960's and 70's patients could not find a parking space at our best teaching hospitals. Progress has been made on that front.

As a Med student I would routinely get physically lost in the huge academic hospitals where I trained and I wondered how the patients and visitors were faring? That too I am happy to report has improved.

Generally though I am disheartened and disgusted by the state of health of most US Hospital. I am freightened for myself, my family and friends who enter at them own risk and for my colleagues who work therein.

What do you want from your hospital? How can we achieve that. Please let us hear from you?

We have a moral imperative not to give up. As America "greys" we obviously need good healthy hospitals more so than ever.

Dr. Rick Lippin
"Blake"

*PS- This essay was in large part stimulated by the proposed sale of arguably the most important piece of 19th century American Art (The Gross Clinic painted by Thomas Eakins) by Thomas Jefferson University for $68 million dollars to Wal-Mart heirs in Bentonville, Arkansas- representing the ultimate "triumph" of the marketplace over the core of what health care should be all about.-ral