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Globe Editorial

First, do no harm

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January 17, 2008

HOSPITALS hide their secrets well, a habit that sometimes endangers patients and inhibits doctors and nurses from doing their jobs well. Beth Israel Deaconess Medical Center is about to begin a program that will open up the institution to inspection by the public and its own staff.

At the urging of Blue Cross Blue Shield of Massachusetts, BI Deaconess will set goals for improvements in patient care and publish quarterly reports on progress or lack of it. The program is modeled after those at Cincinnati Children's Hospital and the Ascension hospital chain. But BI Deaconess has its own ambitious agenda: "to eliminate all preventable harm" by Jan. 1, 2012, an objective shared by its affiliate BI Deaconess-Needham. For the first time in Massachusetts, prospective patients will be able to determine how many errors the staffs of the two hospitals make, and whether the institutions are learning from their mistakes.

In Boston, the popular assumption has long been that physicians at its teaching hospitals are among the best in the world and that the care must be equally first-rate. But as BI Deaconess CEO Paul Levy pointed out in an interview last week, "hospitals are dangerous places." Cutting-edge treatments can be undercut by an infection caused by careless hygiene on the part of the staff. A brilliant bit of surgery can be undone by a misstep by one member of the surgical team. If the hospital staff is rude or uncommunicative, an effective regimen of treatment can seem like a frightening ordeal for patients and their families. The BI Deaconess initiative will encourage the staff to do the simple things well.

"It's getting everybody's attention at the hospital," Levy said of the initiative.

He said he doubts that it will directly affect prospective patients' decisions about whether to choose BI Deaconess. They usually rely on their physicians' advice or friends' recommendations. Regular reports on the patient safety program will serve as an internal communication tool to remind staff members that they are being held accountable and that they can do better.

Levy hopes the program will control costs by eliminating hospital stays caused by defective treatment. That's an important consideration as Massachusetts approaches the third year of its initiative to provide health insurance to almost all its residents. Unnecessary costs need to be eliminated to enhance the affordability of health insurance.

Over the last few years, the federal Centers for Medicare and Medicaid Services and the nonprofit Leapfrog Group, among others, have released comparative data about hospital performance. BI Deaconess, however, is not comparing itself with anything except excellence. Public self-examination may well be the best goad to continuous improvement.

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