The effort to adopt a high reliability approach in healthcare is fundamentally flawed because of a lack of leadership in the US healthcare system. That is the view of Dr Ira Williams, author of a new book on the subject, Find the Black Box.
In it he points out the shocking scale of hospital deaths in the US. He cites Brennan & Leape’s 1990 study that originated the estimate of 98,000 needless hospital deaths annually.
“The most recent estimate is 400,000, plus another 10 to 20 times that number in patients harmed but not fatally,” he told HRMR, citing a recent study in the Journal of Patient Safety that revealed that each year preventable adverse events (PAEs) lead to the death of 210,000-400,000 patients who seek care at a hospital.
He argues that healthcare organizations have failed in their efforts to adopt the High Reliability approaches used in industries such as nuclear power and air travel because of the lack of organizational structure in US healthcare.
“Two fundamental facts of the delivery of healthcare in America are; all medical care is local and states license doctors. Therefore I contend that each state is responsible to create and maintain a functional healthcare delivery system, and no governor or state legislator, past or present has ever had a clue about how unorganized and dysfunctional their state's healthcare delivery system is, and has always been,” he said.
He said that there is no organizational structure within any state's healthcare delivery system that would contain a highest point of authority.
“The reason no Western system of healthcare has ever had meaningful accountability is because accountability is a by-product of authority,” he said.
He added that a comparison of healthcare systems’ organizational structure with the organizational structure of the military or any large industry emphasises the extent of the problem.
“I predict that not one person in any state in America can describe in detail the organizational structure of their state's healthcare delivery system, name each component, describe how each component functions, and then describe how at least some of those components function together in a systematic manner,” he said. “America's healthcare delivery system is devoid of any systematic characteristics.”
US healthcare, Dr Ira Williams, hospital deaths