As RIH spokesmen have been quick to point out, the epidemic of medical errors is not unique to RIH nor is it a recent phenomenon. Ten years ago, the Institute of Medicine reported that an estimated 98,000 patients die in U.S. hospitals each year due to errors. Yet, despite this call to action, a recent study by Consumer Union reported that the number of preventable hospital deaths has not diminished.
As representatives of the more than 2,000 exceptionally caring and talented registered nurses and other health professionals at RIH, our gut reaction is to circle the wagons and defend our hospital for being the outstanding medical facility that it is. But then, we know that defensiveness is part of the problem that has kept hospitals from getting to the root cause of errors. Thus, to more thoughtfully contribute to the analysis and prevention of medical errors, our union has undertaken a survey of our members to ask for their thoughts on how to prevent harm to patients.
From the hundreds of responses that we have received from our members, several consistent themes have emerged.
Listen to employees: Every patient-care area is unique and one-size-fits-all solutions are unlikely to be successful. Employees know the factors in their work area most likely to cause harm to patients. By enlisting employees and their union representatives in confidential, nonthreatening and respectful discussions, the hospital and its patients will benefit from the unique insights that front-line caregivers can offer.
Slow the pace: Too often, hospitals — and physicians — are driven by the pressures of the bottom line. Monthly financial reports (are we doing better or worse than budgeted?) often cause administrative panic and an excessive preoccupation with revenue and “productivity” (i.e., volume and turnover of patients), rather than a singular focus on safety and providing a positive patient experience.
Communicate clear and consistent policies: Employees report that they are deluged with lengthy, confusing and sometimes contradictory policies and procedures. What’s more, each unfortunate event triggers another onslaught of memos and meetings. For employees to understand and comply with frequently changing protocols, communication must be clear and consistent, and employees must be given adequate time to ask questions, give feedback and practice new approaches before they are implemented.
Provide sufficient staff to ensure manageable workloads: Medical and nursing research has repeatedly documented the obvious — when caregivers are assigned too many patients, bad things are more likely to happen to those patients. Over the years, hospitals across America have continually looked for ways to lower the cost of caring for patients. This has led to higher numbers of patients per nurse, even as hospital patients have become increasingly acute. Safe nurse-to-patient ratios need to be established and adhered to in Rhode Island. (California has established such ratios, which offer a reasonable benchmark for Rhode Island.)
Change the culture: Hospitals have historically been run in a hierarchical and authoritarian fashion that causes many front-line caregivers to be reluctant to speak freely about practices that may, or do, cause harm to patients. In particular, physicians are notorious for their resistance to feedback, not to mention criticism, from registered nurses and other health professionals. Administrators, in turn, have typically taken the “bad apple” approach to medical errors, seeking to root out the individual “responsible” for a mishap, rather than focus on “root cause” analysis of systemic factors. While individuals must certainly be held to the highest professional standards, a culture of blame discourages candor and reduces opportunities for continuous improvement and learning.
These are all common sense solutions generated by the very people who work in Rhode Island hospitals. I hope that hospital management takes these suggestions to heart.
Closing Argument 
Too sensible. They’d rather spend the bucks on consultants and productivity schemes.