Monday, June 25, 2012

An answer: Why not an NTSB for Healthcare? II

Continuing this topic: In the seminal Institute of Medicine (IOM) report, "An NTSB for Healthcare", a central question is posed:
Not Why an NTSB for Healthcare ... Why Not?
Medical Healthcare is often compared to Aviation on Quality of Care and Patient Safety, but the comparison is wrong and ineffectual: the story is poor and we're not yet ready to hear the message.

We, as travellers, wouldn't step onto any airplane if Safety and Quality were as variable and haphazard as Medical Healthcare in Hospitals, Primary Care Physicians, Specialists and other facilities.

So why, as individuals and a society, do we accept, seemingly without comment, 1000-fold worse Safety from Medical Healthcare than Aviation?

There are no "smoking craters", nor any vision/images for the media to build a story upon.
There is no big story for the six o'clock News, no individuals' story is 'newsworthy' enough.
"If it bleeds, it leads" cuts both ways...

Describing 100,000 "preventable deaths" from Medical Error/year as equivalent to "10 planes crashing per week" is numerically correct, but an invalid comparison.

Patients don't die all together, they die slowly, not instantly and they are widely scattered - there is a very low density of Medical Error on a daily basis. Each death, although tragic, is invisible.

Medical Error, or "preventable harm", is the leading single cause of death in US Hospitals and seems to be heading in the wrong direction. Which, because Medical Healthcare is a universal, not optional, service, should be causing concern and outrage, instead it goes unremarked and unnoticed in the Media and hence with the General Public.

The more subtle cause is: Preventable Deaths and Serious Injury from Medical Error as not centrally collated and reported.
Even the more complex story, the decline in Medical Quality of Care and Patient Safety, cannot be told because there are no data.

Because deaths and serious injury from Medical Error is so frequent, common and widespread, only the most egregious and sad are reported, like the 2010 preventable and foreseeable injury to Grace Wang, a young first-time mother who was paralysed in Sydney, NSW, through a repeat of a well known Error.

While tragic for the family and friends of victims, those individual stories have no "news value" outside direct acquaintances.
Plus, the sheer volume of individual stories means a cut-off is needed. The time taken to just read 2,000 names every week would be hours and hours of "dead time".

Should then Media report the statistics?
No, as even Stalin knew: A Single Death is a Tragedy; a Million Deaths is a Statistic.

We are our own worst enemies as a society, when we need to address endemic problems:
  • Without "something out of the ordinary", stories have no "news value".
  • We suffer boredom and "compassion fatigue" from long running stories, no matter how terrible.
  • Statistics are not personal, there is no emotional connection, hence little "news value".
  • Nobody is forcing Medical Healthcare to report and categorise 100% of Medical Errors. This removes the possibility of even a larger, investigative story.
Chip and Dan Heath, in "Made to Stick", Why some ideas survive and others die, layout a formula for successful story-telling, or getting ideas to resonate and spread:
  • Simple
    • Makes the story accessible.
  • Unexpected
    • Makes people pay attention.
  • Concrete
    • Makes people understand and remember.
  • Credible
    • Makes people agree and believe.
  • Emotional
    • Makes people care.
  • Stories
    • Be able to act upon it
    • A story's power is twofold: It provides stimulation (Knowledge) and inspiration (motivation to act). Both benefits are geared to generating action.
That these are very hard to do altogether is shown by how few "urban myths" there really are and how little we each retain in detail from the nightly news.

What the estimable brothers Heath don't make much of is a zeroth requirement:
There is nothing more powerful than an idea whose time has come, and
there is nothing less interesting than idea before its time.
The efforts being made to report and address the epidemic of Medical Healthcare Error are earnest, "real", well-crafted and creative. In another time they'd succeed, wildly.

The Public, and hence Politicians and legislators/regulators, are not yet ready to hear this message.
Perhaps we'll hit a tipping point when Healthcare either becomes generally unaffordable or 30% of people are directly affected by serious Medical Harm.

Until then, I hope those fighting this Good Fight can keep their spirits up and continue in the face of disinterest.

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