Improvement time at MGH
THE NEWS that the national hospital accrediting agency found problems at Massachusetts General Hospital points up changes in the inspection system that should improve hospital care throughout the country. Through inspections and other means, government agencies and private groups collect an enormous amount of data about the comparative performance of hospitals. Patients would benefit if it could be collected in an authoritative format that they could understand.
The Joint Commission, the accrediting agency, found that caregivers at MGH weren't washing their hands as often as they should, weren't filling out medical records completely, weren't making sure that patients on pain medication were feeling better, and weren't checking on the drugs that patients were taking before they entered the hospital.
Dr. Peter Slavin, the hospital president, wrote a memo calling this report a wake-up call -- all the more effective because the Joint Commission came in unannounced, unlike its previous inspections, as part of a more rigorous nationwide process. All these problems are easily corrected, and MGH will surely be re accredited.
But how does this renowned institution compare with other hospitals? The Joint Commission, whose task is to assess individual hospitals without regard to the performance of others, is hardly the best place to go for an answer. It's possible that other hospitals had similar sets of problems, but they were not publicized in a president's memo.
Hospitals historically have been reluctant to release data to the public. Paul Levy, president of Beth Israel-Deaconess, courted controversy on his blog "Running a Hospital" last December when he listed the rate of infections for a common procedure at his hospital. He challenged others, including MGH, to do the same. They haven't done so yet.
Levy is to be commended for raising the issue, but self-reporting is no substitute for comparative data from an unbiased source. Private websites, such as UCompareHealthCare, offer some of this data, but the federal government, the largest healthcare payer by far, ought to take the lead. In the interim, the state needs to start work on its own hospital report cards.
MGH is thinking of releasing the final accreditation report by the Joint Commission whenever it is completed. It will be interesting to find out what this traditionally private document says, but if it is written in hospital-speak, prospective patients will get little benefit.
As Slavin's memo demonstrates, hospital caregivers do make mistakes. Patients need a reliable source to tell them which institutions do the most to minimize errors and correct those that occur, and have the best outcomes at treating disease. 