Boston's error reporting strategy may fix military hospitals

With the spotlight trained on problems with accountability and care quality at the nation's military hospitals, these facilities should look to some of Boston's largest hospitals for guidance on how to right the ship, according to an editorial from the Boston Globe.

A U.S. secretary of defense report in October found that while military hospitals generally don't suffer from the extreme and dangerous delays in care that have plagued the Veterans Affairs Health System, eight military health facilities do have "significantly higher than expected" rates of patient illness following treatment, FierceHealthcare previously reported. Those findings were amplified by investigations that revealed lax patient safety standards at military hospitals, and most recently, detailed the culture of silence and reprisals against whistleblowers that hamper facilities' efforts to reduce errors and other patient harms.

To fix the military health system's shortfalls, the Globe advocates implementing a "just culture" model for reporting errors similar to the strategy used by Massachusetts General Hospital, Brigham & Women's and Beth Israel Deaconess Medical Center. These systems use websites available to all employees in which "anyone from a janitor to a nurse to a surgeon is encouraged to report errors in a non-punitive environment," the editorial states. Then hospital executives analyze the reports and take appropriate actions. This system, the Globe reports, emphasizes the reform of the system instead of calling out individuals, whenever possible.

Noting that the chain of command at military hospitals is fundamentally at odds with the just culture model it advocates, the Globe calls for a full system overhaul, aided in part by Army Surgeon General Patricia Horoho, who has made small inroads in increasing transparency. The uncertainty in how long she will remain in her post, however, makes Horoho's role in retooling the system a tenuous one at best.

The editorial also cites the system's division among the three branches of the armed services as an obstacle to reform, echoing previous reports that call for standardization in the military healthcare system to help stem the spiraling costs these facilities incur--projected to reach $65 billion by fiscal year 2017.

With all of these factors in mind, the best way forward for military hospitals is to enact a stable leadership structure that can standardize the system to include a blame-free error reporting model, the editorial concludes--though perhaps "nothing less than an act of Congress" is required for such sweeping reforms.

To learn more:
- read the editorial