Because in every hospital in America, patients die because of hierarchy

The New York Times is running an article about Dr. Peter J. Pronovost of Johns Hopkins Hospital in Baltimore, who's made a career of hospital safety. His work was highlighted in a New Yorker article about 18 months ago. But this particular article highlights the nexus between political culture, physical organization, and method.

It's fascinating to me to see threads common to poor systems implementation and management embedded in the working culture of hospitals: warning signs ignored by "people who count;' workers so beat down by a culture of privilege and overwork that they don't feel that fighting for proper hygiene or questioning a "superior's" decision is worth the battle.

It's also fascinating that he's made a career battling "simple" errors, like not washing hands before treating a patient. The article doesn't plumb the mindset of "superiors," but it does give an overview of problems facing someone attempting to improve organizational culture to better serve their customer.

Best of all, the article ends with helpful tips that anyone can use:


A. I’d say that a patient should ask, “What is the hospital’s infection rate?” And if that number is high or the hospital says they don’t know it, you should run. In any case, you should also ask if they use a checklist system.

Once you’re an in-patient, ask: “Do I really need this catheter? Am I getting enough benefit to exceed the risk?” With anyone who touches you, ask, “Did you wash your hands?” It sounds silly. But you have to be your own advocate."