Date of Submission
Open Access Senior Thesis
Bachelor of Arts
© 2022 Kayla C Kiani
Preventable medical errors are an epidemic. Between 250,000 and 400,000 people die from preventable errors each year in the USA. This investigation questions mechanisms for quality care improvement to eliminate preventable fatalities. I evaluated current patient safety protocols, analyzed their shortcomings, and with additional research recommended actions for better results. Such actions to improve patient safety are explored from three different perspectives: philosophical, economical, and political aspects. In chapter one, improvements within hospitals are reviewed – namely cultural changes needed from both physicians and hospital leadership. Abolishing hierarchical systems which preclude healthy collaboration among medical teams, diverting focus to patient centered care, and regimenting shift hours so doctors’ mental and physical strength are accounted for, cover some of the pivotal changes.
Next, chapter two discusses political approaches – enforced transparency and patient safety processes – only made possible through public policy implementation. Hospitals are public institutions and yet do not report all of their mistakes. However, as proven by the SEC’s regulatory measures required for publicly traded companies, accurate reports foster greater accountability. What is measured improves; what is measured publicly improves faster. Next, aligned incentives promises compensation to hospitals for all procedures if such hospitals prove they followed every safety measure even when they hurt a patient. In converse, hospitals failing to meet the safety measures will not be paid for any procedures, both initial and follow-up for patients harmed by the hospital. I anticipate a steep mistake reduction with transparency and the aligning incentives strategy. It is a win-win for hospitals who will get paid more, patients who will receive better quality care, and taxpayers whose medical tax bills --nearly 20% of the national GDP – will reduce.
Chapter three’s economic focus centers on GPOs’ corrupt contracting tied to their payment structure and concludes with solutions to remedy their incentive for anti-competitive practices. GPOs are the middlemen contract negotiators between vendors and hospitals. Exclusionary GPO contracts preclude the entry of innovative medical products which may provide health benefits to patients. The supplier-based payments to GPOs have perverted the normal supply chain relationship and has resulted in lower quality products, product scarcity, and higher costs which have all led to sub-standard patient outcomes and even clinician harm. Their percentage-based payments from vendor revenue provide perverse incentives for GPOs to charge hospitals higher product prices since GPOs incur incremental benefits with each added dollar a hospital pays. However, while GPOs elevate, except for few GPO shareholder hospitals, most hospitals struggle. Thus, the federal government or hospitals must become responsible for financing GPO activity so this cycle of abuse will stop.
My findings illuminate an interdependency required among all three realms for effective improvements in patient safety.
Kiani, Catherine, "Planning Patient Safety: Philosophical, Political, and Economic Changes Required for Preventable Death Abolition" (2022). CMC Senior Theses. 3069.