Tuesday, January 16th, 2018

Are we missing the mark on patient safety?


checklistStories highlighting patient safety problems in the Canadian health care system appear in daily news reports across our country. The list includes misdiagnosis, drug, lab and surgical errors, dirty hands and dirty instruments, medical charting errors and omissions, unsupervised medical residents, and poor care management.

More hospitals are now using checklists in pre-surgery, post-surgery and intensive care units to help reduce the number of medical errors. These checklists contain a number of items outlining some of the minimal standards for patient care and can be modified to suit the needs of each hospital.

Many argue that checklists are needed for health care providers working in busy hospital environments dealing with complex medical conditions and care. With increasing health care budget deficits and funding cuts to hospitals across Canada, the only real cost for implementing checklists is the time required from health care providers to complete them. It is an easy sell in the name of patient safety but, in truth, the usefulness of checklists is limited.

Medical mistakes may soon be attributed to the failure to include certain items on one of these many lists. This very situation was recently alluded to by the Ontario Minister of Health Deb Matthews following two cases involving a doctor performing unnecessary mastectomies on patients. In an article appearing in the February 24 edition of The Windsor Star, Matthews makes reference to a checklist containing an item that would have prevented these errors from occurring. However, the article also reveals that the hospital where these surgeries were performed already uses a type of verbal check prior to surgery. In light of these cases, another hospital in Windsor is already making changes to its checklist implemented in January.

While checklists may be a helpful tool for encouraging communication and teamwork they cannot ensure provider competence. The ultimate patient safety check resides in the professional and personal performance of each doctor and health care provider using their knowledge, skills and judgement in delivering high quality patient care.

Until we start addressing the lack of transparency and accountability in our health care system and the deeper issues associated with this, the true changes required from both providers and hospitals for driving patient safety remain unchecked.


2 Responses to “Are we missing the mark on patient safety?”
  1. Lee S. says:

    Here’s a newspaper article published two months ago that will explain why Canadians will not get transparency and accountability from their health care providers.


    The health authority in Kamloops, BC obtained a court order to permanently ban a video family members had obtained showing care facility staff abusing their elderly relative in care. The court ordered ban is so extreme, it prevent anyone from even describing what is shown on the video.

    This was apparently done for “staff privacy” but in reality it’s to protect the organizations from legal accountability. When our vulnerable members of society are abused and the health care establishment, the police and even the courts look the other way, where do we turn???

    Staff are now protected regardless of what harm they might do in error, or deliberately. This is beyond frightening.

    The real reason why this is happening is the culture of silence and power that pervades the health care environment. This article by Michael L. Millenson published in Health Affairs discusses this prevalent problem plaguing both Canada and the United States. The full article can be viewed going to the following website, and entering the author’s name in their search tool. Here’s an abstract from is article:

    Michael L. Millenson


    Despite several well-crafted Institute of Medicine (IOM) reports, there remains within health care a persistent refusal to confront providers’ responsibility for severe quality problems. There is a silence of deed—failing to take corrective actions—and of word—failing to discuss openly the true consequences of that inertia. These silences distort public policy, delay change, and, by leading (albeit inadvertently) to thousands of patient deaths, undermine professionalism. The IOM quality committee, to retain its moral authority, should forgo issuing more reports and instead lead an emergency corrective-action campaign comparable to Flexner’s crusade against charlatan medical schools.

    …To remain silent and indifferent is the greatest sin of all.
    —Elie Wiesel

    Nine years ago, while researching the book that would become Demanding Medical Excellence: Doctors and Accountability in the Information Age, I began to catalog the extraordinary number of avoidable patient deaths and injuries attributable to poor-quality medical care. The magnitude of the toll first left me stunned, then depressed, and finally outraged. As I ultimately wrote:

    From ulcers to urinary tract infections, tonsils to organ transplants, back pain to breast cancer, asthma to arteriosclerosis, the evidence is irrefutable. Tens of thousands of patients have died or been injured year after year because readily available information was not used—and is not being used today—to guide their care. If one counts the lives lost to preventable medical mistakes, the toll reaches the hundreds of thousands.1
    The studies that I found then (and others) have since been well publicized by the Institute of Medicine (IOM). Yet the silence within much of the health care community about the true dimensions of the crisis caused by poor quality has changed only modestly over time. Many continue to avert their eyes. Many others pay lip service to clinical systems improvement before almost reflexively channeling the conversation onto a more comfortable path.

  2. Lee S. says:

    Forgot to provide the website where the full article can be viewed.


    The article is listed under PATIENT SAFETY:
    Michael L. Millenson
    The Silence

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