Two Sides of the Hospital Safety Mouth

Hospitals may SAY they are trying to improve patient safety, but the errors are increasing anyway.  While mandating that error rates improve, and making loud noises so the public thinks they mean it, hospitals are at the same time tying at least an arm, and possibly a leg behind their worker’s backs. 

More patients are dying, more are getting sicker, more are being injured while IN the hospital.  All this according to a study conducted on 6,481 patient records over 12 months in the Boston area. They found 1,530 adverse events that weren’t associated with the patient’s original reason for admission to the hospital, an increase of 28 percent after decreasing staffing. The study is reported in the Boston Herald.

In short, these hospitals are talking out of two sides of their mouths. 

On the heals of reading the results of this study, I received an email yesterday from a young woman who got caught in the travesty that has been created in hospitals.  She raised her concerns to the powers-that-be at Johns Hopkins Hospital in Baltimore for situations that created danger for patients — and got fired for her concern.  It seems whistle-blowing in Maryland is a dangerous thing.  She sacrificed herself for the future benefit of patients.  And frustratingly, it doesn’t seem to have helped anything.

Further, according to the stories I hear from patients and their loved ones all over the country, those particular hospitals are not the only ones.  There’s a lot of lip service to improving patient safety.  And it’s a perfect example of how our dysfunctional healthcare system works in the US. It goes like this:

Budgets get cut, and patient care staff are laid off, or hours are cut back so fewer workers are available to patients at any given moment.  The numbers of patients don’t decrease, however, and in places where hospitals or other care facilities have closed, the numbers of patients in the hospital will increase. 

Safety and caretaking require attention to details — details such as double checking medications, verifying which patients are which, transporting patients properly through the hospital, administering treatments correctly, even operating on the correct body parts.  When personnel become stretched so thin, the first thing that goes is attention to detail. 

Think of it this way.  You and your spouse have two children.  They are both demanding, as children are.  You must pay attention to all your daily caretaking details from feeding them, to keeping them clean, to getting them to and from school and overseeing homework, to making sure they don’t get lost, to providing a roof over their heads, to making sure they don’t watch TV that could skew their thinking to this and that and the next thing, to saving for college — everything.

Now one of you goes away from divorce or death or for whatever reason.  Not only is the remaining parent’s workload double, but you have the additional challenge of trying to keep it together emotionally because you are upset that you are no longer working together to raise your children.  You still have all those child raising details to take care of — and you have the additional stress of managing the details associated with the halving of personnel to do it.

Studies abound at the detrimental effects on children of being raised in single parent households (and believe me — I’ve read them — I was a single parent for most of my children’s upbringing). 

How can we expect care in a hospital to be safer when we put patients in the hands of fewer people who can attend to details? 

The bottom line for patients is this:  despite what they tell us, despite what they publish, despite the noise they make while you are there — hospitals are dangerous places.  They become more dangerous when fewer people are there to attend to details. There is too good a chance you will experience an adverse event if you spend time in a hospital.  So you (or your loved one) will have to be very diligent about attending to all those details that the workers may miss because their ranks are stretched so thin.

There is a good guide for hospital consumers put out by Consumers Union.  If you find yourself facing a hospital stay, then take a look.  It’s worth your time and may save your life.

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1 Response to “Two Sides of the Hospital Safety Mouth”


  1. 1 Kim Sanders-Fisher April 26, 2007 at 1:00 pm

    The fan fare of public pronouncements about the priority of patient safety may give unwary employees a false sense of security when they feel compelled to report negligence. This should never dissuade Hospital workers from following their conscience, but they must proceed with the greatest of caution to anticipate the worst possible reaction and avoid the pitfalls of retaliation. As the aforementioned Hopkins employee I felt deeply betrayed by all of the glowing PR “Spin.” I was torn apart by feelings of disloyalty towards colleagues I genuinely respected and I had felt truly privileged to work alongside. I remain incredibly proud to have worked at this prestigious institution, but I realize even the “Best Hospital in America” has fallen victim to the current poorly conceived market forces. . It was not the people, but the system that failed.

    The good news is that there are solutions. The levels of what I have come to refer to as “Deliberate Negligent Understaffing” have put patients at serious risk, but this situation is entirely unnecessary. The US does not have a “Nursing Crisis” it has experienced a “Nursing Exodus!” There is strong evidence to suggest that Nurses who have left their chosen profession due to the toxic work environment have still retained their Nursing licenses. If the circumstances that drove them away were to change then many could be lured back into our Hospitals. Although I am not myself a Nurse, as a Surgical Technologist it training to become a First Surgical Assist, I realize how critical appropriate Nurse to Patient ratios are to the delivery of safe medical care.

    There was a point when Healthcare facilities all across the US decided to make budget cuts. Consultancy firms were enlisted to show us where we needed to “trim the fat.” From my experience with three such surveys in two different Hospitals the main financial drain in all cases was determined to be the result of top heavy Management. However, when it comes to “the fat” Managers control who and what gets “trimmed” so, ignoring the evidence, benefits and conditions on the direct care level were targeted for drastic financial cuts. This created the toxic work environment responsible for the Nursing Exodus; it also meant fewer cleaning staff with poor oversight resulting in sloppy hygiene and increased infection rates. What made so many Nurses decide to join temporary staffing agencies or quit Nursing altogether? Many felt abuse and manipulated into dangerous situations by “Deliberate Negligent Understaffing.”

    The obscene Management glut has remained as bloated and ineffective as before, if anything it is now even more top heavy. Managers are higher paid than regular Nursing staff so we know what must be done to correct the grotesque imbalance. Gutting the ranks of top heavy Management would liberate funds to support safe Nurse to patient ratios. We could also adequate fund ancillary personnel for cleaning, transport and relieving Nurses of non-clinical roles so that they are liberated to concentrate on the care of their patients. No one should be so overwhelmed at work that they are constantly in fear of making a serious mistake that could harm a patient. The most important ingredient for US Nurses to rejoin the medical workforce is the knowledge that they will be empowered to deliver appropriates standards of care.

    Management strenuously apposes these views and the slightest mention of “Deliberate Negligent Understaffing” will get you fired: I speak from experience! Conscientious medical professionals desperately need powerful Whistleblower protections. They will continue to try and advocate for the safety of their patients, but without retaliatory protections they are easily removed. Once discredited by firing their warnings and protests are effectively silenced or ignored, and worst of all absolutely nothing is accomplished. I have petitioned Johns Hopkins Hospital to use their considerable power and influence to redress these important issues via an investigation into what went wrong in my case; the details are on my Blogspot, my Care2 home page and the Petition Site. I hope peaceful protest can deliver results that are in the best interests of patient safety,
    Kim Sanders-Fisher.


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