Saturday, April 16, 2011

Health Reform: Hospital Safety and Cultural Change

April 16, 2011- This last week I came across two articles that alerted me to the necessity for cultural change on the part of hospital caregivers and visiting physicians.

One was by Maureen Dowd, the New York Times columnist blaming doctors for the death of her brother from infection, because they were distracted and wore ties in the ICU; the other was by Richard Platt, MD, from the Department of Population Health at Harvard Medical School.

Both were asking for culture change and increased awareness of the dangers of hospital infections.

Their message did not fall on deaf ears. I have been saying for years that resistance to cultural change and ingrained behaviors are what make health reform so difficult. This is true for the nation as whole, which is conservative and reluctant to change, as well as for doctors, who prefer the status quo, the devil they know, to the unknown demons of reform, which often descend down from Washington.

This resistance came into focus this week with the news that the government has launched a hospital safety campaign to protect patients in hospitals from hospital-acquired infections. The goal is to save $10 billion by avoiding 60,000 hospital deaths from medical errors and hospital infections, particularly from Methicillin Resistance Staph Aureus (MRSA) infections.

In the NEJM editorial, Platt notes that hand hygiene, spotting MRSA carriers, avoiding ventilator-associated pneumonias and central-line infections, warning signs on infected patients’ doors, and rapt attention to “prevention bundles of care” dramatically reduce deaths, particularly in ICU settings.

To achieve these results across the nation, Platt concludes, “it will be necessary to change the culture of clinical care.” By this he means systematic , organized, and purposeful changes by teams of caregivers collecting data and implementing changes over time across the hospital environment.

This will not be easy in a culture that cherishes autonomous behavior by individual caregivers. The government has said it will address the problem by withholding payment for certain hospital-acquired infections.

Whatever happens, it is apparent that a cultural change stressing an increase in vigilant precautionary measures over time will be necessary, both by caregivers within hospitals and visiting by physicians. Hospitals are dangerous places. Perhaps this danger will serve as a spur for systematic cultural changes.


1. Maureen Dowd, “Giving Doctors Orders,” New York Times, April 12, 2011

2. R. Platt, “Time for Culture Change,” New England Journal of Medicine, “ April 14, 2011.

Tweet: Protecting hospital patients against infection requires a systematic cultural change and team effort among caregivers and physicians


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