Recently, the death of a 4 year old girl following routine surgery in Iraklion, Crete has drawn much attention. In light of this, the way in which medical error can act as a stimulus for health care system reform is worth examining.
Medical error does not mean negligence or momentary lapses in judgement of individuals. Exposés of medical scandals show that fatal errors are the result of a series of shortcomings. Rarely is only one person to blame (logical enough, since medical practitioners work in teams).
Our stance towards the anesthesiologist involved in this recent case, who accepts part of the blame for the death of the child, is minor detail. This is because no doctor (in a hospital environment, at least) can or should act alone. The situation is more complicated than the guilt or innocence of an individual.
International experience shows that systemic errors are often the culprit for patient deaths. This is the case, for example, at the Bristol Royal Infirmary in the UK, where a high number of child deaths after cardiac surgery were recorded. The inquiry revealed that staff shortages, a lax approach to safety, secrecy on doctors’ performance, and inadequate guidance and coordination by management, all played a role. Those deaths were not considered “isolated incidents”, but symptoms of serious underlying problems. This led to a stricter framework for pediatric cardiac operations, and a clearer set of evaluation criteria for doctors.
The term “evaluation” is often met with hostile responses in Greece. Many argue that medical practice cannot be evaluated through metrics. This is true to some extent. Yet it is wrong to presuppose that evaluation requires measurement and ranking to be effective. To go back to the case which inspired this article, evaluation could be linked to targets. For example improving coordination between hospital teams, hospital units and between different hospitals. It is unacceptable that, in 2016, the relatives of patients or even the Ministry of Health must intervene before a bed in an Intensive Care Unit is found. We need to look at entrenched attitudes and beliefs, and redesign the system to change them.
At its core, evaluation assesses how well a design works. While good design can often be measured, the qualitative aspects of the experience cannot be ranked, yet they shape it. It is with this mindset that evaluation approaches need to move forward.
Currently, a health care reform programme with specific targets exists. Yet the state hospitals are in is like the state of other public services. Poor coordination and accountability, fear of responsibility – these are but a few of the ills of public administration. It looks like they may never be defeated.
We have yet to see if, and how, the case in Iraklion will affect developments in the health care sector. A sector in which responsibility, accountability and patient rights are obvious prerequisites.