If you’re a “boomer”―one of those Americans born between 1946 and 1964―you have witnessed the most dramatic changes in history in the essential community institution called the hospital. From the technology inside to the kinds of people who deliver the medical care and operate the organization, and from the financial structure that supports it to its image in the eyes of the public, today’s hospital has been radically reformed in the past few decades.
Most Americans don’t like to think about hospitals; they enter our minds only when they must. There’s only one time in the life of a family when they want to be in the hospital. All others are moments of fear at best, human crisis at worst.
As a full-fledged boomer, I remember my early impressions of hospitals: big, mysterious places that sometimes didn’t allow children in. The grownups I knew talked about hospitals with a curious mixture of reverence and fear. If someone died in the hospital, the common notion was that the doctors “did all they could, but Uncle Fred didn’t make it.”
If, heaven forbid, a person faced hospitalization, he or she went wherever the doctor directed. In my small hometown, everybody knew somebody who worked at the hospital, so you at least knew that if you had to go there, you’d see people you knew. And if you knew the people, you trusted the hospital to be a good place where good people did their best for you. And that was about all the information most people had about their local hospital.
Today, the public pressure for information about the inner workings of hospitals is coming from every direction― regulators, politicians at every level, the press, organizations claiming to represent “consumers” and distinct groups such as the elderly and uninsured, unions, the business community, and the list keeps growing. The demand is for an unvarnished took at what occurs in every place, from the boardroom to the billing office to the bedside. How do hospitals govern themselves? Whom do they pay how much? What prevents conflicts of interest? What do they charge for their services, and who actually pays what? What are the policies and practices on charity care, billing, and collections? How many errors do the clinicians make? How many people get infections in the hospital? What are the outcomes of the care? Are patients getting the right care at the right time? Do patients get too much care? Too little? What do you do about inept doctors?
It’s a virtual tsunami for transparency. And hospital people are reacting to this tidal wave in multiple ways. Some are running away from reality. Some are standing their ground. And some are adapting and changing to survive and thrive in an environment vastly different than anything their careers have prepared them for so far.
Because hospitalists are a growing presence and are playing an increasingly important role in all aspects of quality and patient safety, they will be critical to the hospital’s ability to adapt successfully to this new era of transparency and accountability.
The public’s attitudes toward medical error reporting and hospital acquired infections and how hospitals are responding to them today are important clues to the future. In 1999, the Institute of Medicine released its now famous report, To Err Is Human. It estimated that between 45,000 and 98,000 Americans die in hospitals each year from preventable medical errors. The report was nuclear. Not only did it open a national debate on patient safety that continues still, but also it compelled thousands of hospitals to talk with their communities for the first time about what they do to prevent errors.