Fundamental patient care questions all hospital leaders should ask

Hospital administrators across the country should ask themselves six important questions to uncover and tackle systematic problems within their organizations that may lead to inadequate patient care, according to a HealthAffairs blog post.

Healthcare attorneys S. Allan Adelman and Lewis Morris questioned the role of hospital leaders after reading an essay by Jonathan R. Welch, an emergency medicine physician, who wrote about the errors he witnessed that were made in connection with the care provided to his mother. Despite his mother's classic signs of developing sepsis, he wrote that nurses and the medical staff ignored the symptoms and provided indifferent care while he watched helplessly and she ultimately died.

Instead of blaming the nurses and doctors, Adelman and Morris argue the medical errors were due to deeply rooted systematic problems at the hospital. To avoid a similar occurrence, they suggest hospital administrators take an honest look at their organizations to make sure Welch's experience is not repeated at their hospitals.

"Hospital board members should sk themselves, 'If I were asked by a friend or colleague whether this could happen in my hospital, would I be able to answer 'no?'  More importantly, would I be able to answer the follow-up question: 'How do you know?'" they wrote.

The article asks leaders to consider whether:

  • Political or cultural barriers interfere with a patient receiving appropriate care
  • Nurses are comfortable discussing patient care with attending physicians
  • Nurse managers would be aware of and act on the situation
  • The organization would have conducted a root cause analysis of the event
  • Medical staff would have initiated a peer review of a similar case
  • The organization has a process in place to deal directly with patients and their families about adverse outcomes

To illustrate their second point, the attorneys remind hospital administrators that a culture of deference to a physician or a strong personality of a doctor may make nurses hesitant to contact a doctor about a patient's worsening condition.

"Nurses are the healthcare providers who are most in touch with the patient's condition and hospital leaders need to empower them to speak out whenever they feel that a patient's needs are being neglected. Moreover, if nurses do not get satisfactory responses from a physician, they should know how to go 'up the chain of command' and have no reluctance to do so," they wrote.

To learn more:
- read the blog post
- read the original essay by Welch

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