Medical professionals make mistakes. But could those involved in medical training be teaching those mistakes to the next generation of doctors?
That’s what a recent STAT analysis on teaching hospitals aimed to find out.
Teaching hospitals, or hospitals affiliated with medical schools, are where young physicians start out. Some of them train doctors destined for national recognition, as academic institutions home to the cutting edge of patient care.
But, according to STAT’s findings, even the most prestigious of teaching hospitals aren’t immune to terrible practices.
Study Shows Troubling Trend of Medical Errors at Teaching Hospitals
In their analysis of federal inspection data, health publication STAT noted significant disparities in training quality at the nation’s 1,200 teaching hospitals receiving Medicare payments. The majority received no patient safety violations between 2014 and 2017. Others racked up dozens each.
In total, more than 5,500 safety violations occurred over the 4-year span. Each year, at least a quarter of teaching hospitals reported 1 or more safety violations, with a major spike in 2015 and 2016. These included everything from failing to wash hands in a pediatric unit to shrugging off psychiatric treatment for 2 patients who later committed suicide.
The most citations went to West Valley Medical Center in Idaho with 45 violations, Regional Health Rapid City Hospital in South Dakota (44), and Howard University Hospital in Washington, D.C. (37). And among the others? Some of the nation’s most revered medical centers, including those affiliated with Harvard, Columbia, and Case Western Reserve.
CMS cited medical trainees as responsible for some of the violations. However, in many cases, their leaders were responsible. And trainees who witness their supervisors’ indifferent approach to patient safety may not have a promising future.
Where It All Began
For decades, preventable medical errors were accepted as an inevitable part of the healthcare system – particularly in training. If something went wrong, health administrators would simply scold the trainees. Nothing would be done to investigate underlying systems that allowed the mistakes to occur.
Dr. Sumant Ranji, an internist affiliated with several San Francisco hospitals, said hospitals still promote a “pernicious old-school culture”: A belief that learning happens through making mistakes, even in the context of life or death.
Trainees privy to these errors inevitably experience “profound psychological consequences,” Ranji said, but don’t always feel empowered to speak up.
In 1999, the Institute of Medicine issued a landmark study that brought this severe public health threat into the spotlight. The Institute’s report, “To Err Is Human,” revealed that as many as 98,000 Americans are killed in medical care. The most recent research inflated that number to 440,000. Meanwhile, scientists have jostled for answers to the common types of medical error behind not just death, but the lifelong consequences of birth injury, adverse drug events, and more.
Still, almost 2 decades on, the cycle continues. Worse: The medical profession knew what was going on long before 1999. But even under threat of inspection, hospitals and staff chose not to act.
Hospitals Scramble for Solutions, but Are They Enough?
The Accreditation Council for Graduate Medical Education, which regulates more than half of the country’s teaching hospitals, recognizes these institutions as a large part of the problem. STAT found the Council made efforts to step up its policies, sending staff to interview administrators, shadow doctors, and raise awareness of trainees’ important role in reporting medical errors.
A few of the hospitals themselves have also made positive changes. At the University of Chicago Medical Center, for example, residents must undergo rigorous patient safety training and are strongly encouraged to “raise their hands,” when they see a problem. The hospital hasn’t received a safety violation in 2 years.
Hospital- and accreditor-level policy changes combined, the average number of violations per teaching hospital has dropped to its lowest in 3 years. But experts worry this isn’t enough. There’s still enough margin for error to make future doctors ill-prepared to practice.
“If residents train in a program where patients aren’t receiving safe care, [they’re] likely at increased risk of burning out or leaving clinical medicine entirely, or providing not as good of care if they stay in clinical medicine,” Ranji said.
Medical experts also warn that CMS reports only scratch the surface. Matt Austin, a professor at Johns Hopkins University’s medical school, said they reflect an “important, but not a complete, picture of patient safety.”
Breaking the Deadly ‘Culture of Secrecy’
To improve safety in U.S. teaching hospitals, suggests an essay in the New England Journal of Medicine, we must pay more attention to hospital environments. It’s often “organizational design” and holes in the system that allow mistakes to slip through, rather than the person believed to be at fault.
But let’s not forget that individuals have a duty of care to uphold – and patients have every right to hold them accountable when it’s violated. For too long, hospitals have fostered a culture of fear and secrecy in which doctors prioritize their reputations over admitting mistakes. This not only allows the problem to persist, but prevents doctors from learning effectively from each other.
Future doctors hold the keys to ending this continuous cycle of errors. But are retroactive efforts enough to reverse damage to their education and their patients?
“In the places where young doctors-in-training practice, what they learn can affect how the person will practice for decades to come,” said patient safety advocate and writer Rosemary Gibson. “They’re developing habits.”
And the way things are going, these habits aren’t good.