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Massachusetts health care — wonky, with a healthy dose of reality

Changing the Culture of Silence

Changing the Culture of Silence

April 11, 2013

Brigham and Women’s Hospital has been leading the way in transparency around medical errors, as a recent Boston Globe article reports.  The article details the implementation of an initiative to inform hospital staff about mistakes made in the hospital via a newsletter, distributed to the hospital’s 16,000 employees.  Issues of the newsletter include anonymous interviews with both patients and doctors concerning the issue, as well as information about recourse after these incidents.

The efforts of the hospital run against a long-standing trend of silence surrounding medical errors. Hospitals often are reluctant to circulate information about medical errors due to fears about malpractice lawsuits or fear from the public. Yet transparency efforts, like those demonstrated at Brigham and Women’s, can do much to foster a culture among staff which could focus on preventing future errors and modifying existing systems to ensure patient safety. And the particularly visceral effect of reading specific stories is likely to change the behavior of doctors far more than a long list of quality statistics. Patient advocates are optimistic as well – Linda Kenney, the executive director of MITSS (Medically Induced Trauma Support Services), appreciated the move towards a culture of openness. “I like the idea the Brigham is encouraging people to speak up,’’ she said.

Yet the impact of the newsletter has been more than theoretical: in fact, a “pretty dramatic experience” recounted in the newsletter concerning emergency room wait times pushed the department towards efficiency, reducing wait times to 20 minutes and expediting the process of bringing in extra help. A story about the damaging effects of a doctor prescribing contraindicated medications led to mandated doctor-pharmacist conversations about medication side effects.

These newsletters serve as a critical jumping-off point for Brigham’s troubleshooting process. Dr. Elizabeth Nabel, the hospital’s chief executive, created the program in an attempt to mitigate the shame around medical errors. And although specific data on changes in quality care since the implementation of the “Safety Matters” newsletter aren’t yet available, the increase in transparency marks a promising shift in the way providers can approach patient care.
-Devon Branin