Accountability may end with CEO, but starts on the floor

This week, our sister publication, Hospital Impact, ran a moving column by Beth Israel Deaconess Medical Center CEO Paul Levy in which he talks about how he and two other CEOs discussed their handling dangerous miscarriages of care that took place in their hospitals.

CEO Paul Wiles of Novant Health in Winston-Sale, NC, spoke about an infant's death from sepsis in his hospital, ultimately tracked to an MRSA infection on the neonatal ICU. Greg Kutcher, CEO of Immanuel St. Joseph's Hospital of Mankato, MN, described how a fentanyl-addicted nurse had emptied vials of the drug and refilled them with saline solution, which then resulted in cardiovascular patients getting these contaminated doses. Then, Levy got up and described his hospital's handling of a wrong-side surgery case.

The three CEOs seemed to share a single  philosophy that the buck stopped with them and that they were ultimately responsible when problems like these took place. They also agreed that complete transparency about mistakes and process issues causing the mistakes was a critical tool in the CEO arsenal.

All this is well and good, and and an appropriate stance for a chief executive. That being said, I think this picture leaves something to be desired, in that it doesn't address the role of day-to-day clinical staff in heading off these problems. Sure, setting the tone and addressing big operational issues is important, but empowering nurses and doctors is even more so.

Hospital nurses, in particular, seem to feel that no one hears them when they mention problems that they see. Every week, I get letters from nurses who say that no one listens when they identify critical patient care concerns--that they're passed over, patronized or ignored if they make a fuss. Doctors may get a bit more attention, given their role as referral sources, but often they have little impact on larger processes either.

Perhaps these CEOs, in their self-examination, might want to stop and look at how empowered the people closest to the problem really are. A nurse who sees a patient getting the wrong dose or the wrong drug can do more to save lives than any abstract cultural change, but unfortunately, they don't always get a hearing. If you want to improve care, Mr. CEO, there's a place to start. - Anne