LS 27 - Closing the Communications Gap Between Patient and Staff with Steve Powell author of The Patient Survival Handbook

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Welcome to the Longevity Show. Informing listeners on the important aspects of health, wealth and happiness to ensure you live life to its fullest. With fascinating interviews with top authors and gurus in the field, along with the latest news in the science and technology of longevity, we're going to reveal expert advice and amazing secrets of living a longer, happier life. And now, here's your host, Jason Hartman.

It's my pleasure to welcome Steven Powell to the show. He is the author, well, the president and CEO of Sinensis and author of the Patient Survival Handbook. Avoid being the Next Victim of Medical Error. This is obviously a big, broad ranging issue, affects many people every year. Steve, welcome. How are you?

Hey Jason. I'm fine, thank you for having me today.

Good. So tell us how big this problem is with the medical error issue.

Well, the issue's bigger than we really think. I think initially we felt like that from the early evidence around 15 years ago, we believed that maybe as many in our country, as many as 100,000 lives were lost as a result of preventable medical error just in our healthcare system alone. And more recently we're learning from more advanced techniques of uncovering these root causes, causes of these, these events, that, that in actuality maybe as many as 400,000 deaths are the result of preventable medical errors in our, our health system in the US alone.

And just to put that in context, I mean, you know, when people talk about say drunk driving as a cause of death, that I believe, I haven't kept track of the stats in many years, but I think it's around 25,000 people a year maybe die in car accidents overall. I don't know how many of those are DUI related, but you know, this is, this is big.

Well, it is. I mean I could do it, put it in two, it's about, it's about eight times the combination of all deaths from, from AIDS and from automobile accidents together combined. And then if you, if you also look at it as a leading cause of death in our country, it's only, it's third only to the, the more well known heart disease and cancer deaths. So, so this is problem in our system and I think the key about this is that it is truly preventable. I think that's where, where we're, we're really keen to, to make an impact on, on those preventable deaths. So to try to turn time.

Why are we hearing more about it though? Is it Cover ups. I mean, are the doctors just, you know, they, they're not bringing up the issue because it's, it's them who, who is at fault or their system at least, whereas they're always talking about cancer, heart disease, you know, everything else. Because those are huge profit centers, obviously.

I think you may have hit on it, Jason. I mean there's, there's a couple of reasons I think one is, is that this is sort of negatively impacts the bottom line. So you're not really going to want to talk about the things that negatively impact the bottom line. And these are huge costs to hospitals when they have a preventable medical error and a patient dies. This, you know, as you can imagine, there's huge liability for this. Not to mention there.

There are financial penalties from our reimbursing sources such as Medicare and Medicaid in our country. So there are huge write offs that an organization would have to make financially. But it's also tremendously harmful to your reputation out there in the healthcare space.

And I agree with you. I think a lot of these are possibly not becoming visible because of the lack of transparency because I think physicians and nurses and those hospital leaders, they're actually fearful of reporting these events because of the ramifications and what it could mean to them personally. They could lose their job. So there's truly lots of dynamics going on. I think there's another dynamic too of why we don't know about this and that is that these deaths actually happen one death at a time and they happen in various settings across our entire country. And it's, it's usually a, an ISO seems to be an isolated incident. We don't really have a national, if you will, independent investigation of these events in our country like aviation would have in the National Transportation Safety Board or.

In, where it would happen all at once. There'd be a plane crash that would affect many people.

Yeah, exactly. So we're seeing these once at a, one at a time.

Well, the other thing is it's hard, it's a little harder to define this. You know, one of the big problems in hospitals is infection through IV lines. You know, it's just a matter of the nurse using some rubbing alcohol for about 30 seconds and making sure that those fittings are properly wiped off. Right. That's a, that's a big part of it. And you know, that kind of error, you almost, you really can't trace it very well. I mean, you know, you don't know who did it, what shift it was, you know, exactly. When an infection enters the patient's bloodstream. Right. You know, it's hard to point out a specific person always.

Absolutely. And I think that that's the important side that you just hit on, Jason, is that this isn't really. This problem isn't as much an individual problem as it is a system problem. And so we need to create safer systems in our healthcare system that would prevent us from making mistakes like creating a situation where a patient could acquire an infection by something we didn't do or were supposed to do. So errors of commission and omission. So it really needs to take more of a systems approach to that. Now, whether or not we can, one of the issues here around hand hygiene is that many studies in our country around hand hygiene in our hospitals has shown that actually hand hygiene rates are actually better in restaurants than they are in a hospital. And so when you do audits of your hand hygiene practices, you find that they can be less than 50% compliant with the hand hygiene hygiene, you know, rules or regulations. So I guess what I'm saying around that, Jason, is that we're actually also not, you know, we're not hardwiring some of these behaviors into our practices. And there's a lots of reasons why that that's happening. You can make all kinds of reasons why we don't follow a rule, because we all are out there in our daily, our daily endeavors, even driving, where we might break the speed limit, and we choose to drive faster than what's legally, you know, mandated. So the same thing may true in some of what we would call these workarounds that are happening maybe because of work pressures to create a more efficient movement of patients through the system as opposed to the effectiveness that comes from delivering safe care.

Okay, so tell us about the common error. What are the most common errors?

Well, some of the most common errors, 70% of these most serious events are the result directly related to ineffective communication. And this communication, believe it or not, this communication, 70%, this is not, it's not unique to healthcare. Other industries that are high risk, like aviation, nuclear power industry, the military, they find that they run into the same human error causal factors for the most serious events. This is communication between doctors and nurses, but it's also communication between the healthcare provider and the patient and their family. And that's what the Patient Survival Handbook was designed to do, is it's designed to go right after the core of these problems, and that is that interaction between patient and family and the healthcare provider or professional, and try to close some of those gaps in communication. That are going on. Those are the number one when you transition to care in other settings. So you move from maybe a hospital to a long term rehabilitation facility because of continued medical care, that jumps to 80% of those events are a result of ineffective care communication. So we went right after the most common cause of this. There are other reasons. Many of those reasons result in other really related human factors. The fact that we are human and we do make mistakes is a lot of the reasons why. This could be workload pressures, it could be our failure in our memory, it could be that we are fatigued. So there's quite a few things working against us as humans in the healthcare system just like in other high risk areas.

Well, I have never understood, and I mean after talking to many doctor friends over the years, I have never understood these long shifts. I mean that is, that just seems incredibly dangerous for patients. Why is it that these, you know, that these residents and doctors and nurses, you know, why are they having such long shifts? People in offices don't work such long shifts and they're doing a much less critical activity most of the time.

So again, you hit on a really key aspect of this is that you have to know this going into this, that there's more than likely as you get towards the end of any shift because there is a shift working mentality is that at the end of that shift the healthcare provider is compromised in their ability to make decisions, their ability.

To follow a prescribed protocol in sequence. Because these are just human cognitive, if you will, frailties we have in our system, the more fatigued we are. You know, imagine this, the resident, which is the physician under training, their work hour, weekly week hours is 80 hours is the maximum that they can work per week. And that was an improvement that was put in place.

I mean the FAA would never allow that for pilots.

No, they wouldn't allow it at all. And in fact they have much more stringent hours around. You know how many hours a pilot could work and be on duty. And this is even worse if we're on duty in what's called the backside of the clock. So when you're receiving care in that period, somewhere from, you know, anywhere from about 11pm till about 5am in the morning, because again, human performance, no matter who you are, it's degraded in that backside of the clock. But yet Healthcare is a 24, 7 operation. Nurses are a different story, Jason. Nurses, like a lot of us, they actually prefer these longer shifts, 12 hour shifts and they'd rather work four days in a week than to work five days in a week. And there's, unfortunately, we kind of allow some of these work preferences that we're trying to be flexible around work scheduling because there's a desire by a certain group to have a four day week versus a five day week immediately changes the dynamic around how many hours a day that is actually safe for that person to work. 12 hour shifts are just more dangerous. The evidence is quite clear. And then when you take these physician rotations where they could be on call for 24 hours, it truly is, your physician is truly impaired. In fact, there was a study done where in around the 18th to 20th hour that physician's on duty, that in the studies it was equivalent, their performance degradation was equivalent to a drunk driver when they did some psychomotor tests, testing.

Well, they've done many studies on driving while sleepy and saying that it's more dangerous than drunk driving. So this is just unbelievable. How have we let this happen? It is ridiculous.

Well, and again, as you kind of look at this, you sort of look at the healthcare practice of medicine is just that we have been, I would say, slow to adopt, you know, best industry practices from not only within healthcare, but outside of healthcare. And so this autonomous nature that we enjoy within healthcare that in some ways helps us to try to, you know, create the right treatment plan or assessment plan with a unique situation. It doesn't really help us well in that sort of, if you will, 80% of the time when we're just doing the normal, everyday practice of medicine where we could really benefit from safety structures, what we would call sop, safe operating procedures and, or standard operating procedures. And also we would benefit from thinking as simple as using a checklist like a pilot would use, that would help us remember certain steps and activities. And if we follow that, you know, in a, in a very reliable way, each and every time, it would keep us from actually doing this. So that's the key to preventable error, is that we actually know how to prevent these things from happening. We just absolutely don't have either the will as a system or the personal accountability or the leadership to actually make those actual actions.

Where does the AMA stand on this? The American Medical association, where are they? I mean, they're probably, I don't know, I have a feeling they don't much care.

Well, I think, I think they do because I think at the end of the day where we reach physicians with this message of safer practice and where I believe they are keen to do this is.

In the Hippocratic oath. It says first, do no harm okay. And we would say first do no preventable harm. That would even be before harm. Is that really, it's core to physicians. And so they're all about patient safety.

They're just having a very, very difficult time in this changing healthcare environment of ours, where to try to create health, be part of the solution and engage in a conversation around safer systems. And doctors are going to be crucial to actually making this happen. And I think the book that we've written has really sort of also been, I think it can be, and we've heard this from physicians who've read the book and looking at the book, is to say they're really trying to find better ways to better engage with their patients and families in their own care, to make them safer and for them to have a better experience and a higher quality experience. But, but I believe patients have to become it, come into this, if you will, this chaos that we're talking about and help us solve the problem that exists. We're not going to be able to do it without patients and families.

Well, how can patients do it? I mean, why is it the patient's responsibility? This is, you know, the patient is obviously compromised. That's why they're in the hospital.

Right, exactly. And I, but I, but I think we have the most at stake here. Okay. Because at the end of the day, the error actually occurs to us. And this costs us in our, you know, the loss of a loved one, you know, a brother, sister, mother or father. But it also costs us in lost work days and productivity and being able to provide for our families. We have the most to lose here. We have more to lose as patients and families than even the healthcare has. Even in the financial losses that they may suffer, we have much more to lose because we can't replace our loved one. And so it's really important for us to gain knowledge and insights and awareness and be able to come to our healthcare professionals and really become part of the solution, engage with them.

Ask them questions, bring advocates with us to speak on our behalf when we're not able to speak on our own. We need to be more advocate, more for our own best care and for our own choices. And to do that, need information. We need to know what to ask. And I think the book helps really, patients take that step forward in being advocates for their own care and the care of their loved ones.

Okay, so asking questions to me seems like a, you know, somewhat weak thing, but maybe it's all we can do. Share with us some of these questions we should be asking.

Well, I think, I think a question we really should be asking is, is, is that, that fully, does the physician, do they actually understand what's happening to you? So that could be one question. Do you believe that the physician or the nurse or the person who's seeing you understands your problem? That's number one. Number two is, do they understand my situation? Do they understand the medications that I'm allergic to? Do they understand my history? Do they know what's happened to me before this event that I'm here being seen for? Do they, what do they expect to happen next? Do I understand, in fact, what I'm going to have to do? What are my responsibilities to ensure when I leave a hospital that I'm able to actually follow all of the instructions that they've given me? So these are questions that I can ask. I think one of the most valuable questions we learned this was given to us from a physician that he loves. This question asked of him by patients when they go through an assessment of your condition to try to understand how to best treat you, is they give, you know, their idea of what's wrong with you. And they love when patients ask them, do you think it could be Anything else? Dr. Because it's in that question that we ask our physicians to go through one more loop in their decision making process and to maybe rule out some things that it could be something else. And in what we're doing is we're partnering them because they are human, they will make mistakes. And we're starting to bring up things and point out issues that we see as possible gaps in our care that may not be recognized by this flawed system that we have in place. I think another action that we can take to be very proactive is we can also ask.

Our physician, our hospital, our local community place, that we get treatment, maybe our clinic, if we're ready to be more.

Take more action, is to actually be involved in a patient and family advisory council where we represent the voice of the patient in our community or in our local town or in our city. There are many more of these being formed by hospitals and clinics. Daily we can start getting into the conversation around safety and quality from the perspective of the patient. And that's a huge step that we could take because in fact, a lot of what's done inside of the hospital are based on the dynamics of the actual caregivers, the physicians and the nurses and the administration, and some of how they do their insurance and billing process and all of this sort of side. But, but they're not getting the perspective of the patient. And they really, really are in need of that perspective. And so they need our feedback. If as another.

Another area, any resources you can share as far as getting an advocate, for example, say someone, their family isn't that engaged or aware or available.

Absolutely. In the book we in each of the book is separated by. There's several different sections. It depends on where you are in the healthcare system, is how the book's arranged. So it's not probably to be read cover to cover. It's probably read when you need it for where you're getting care. Whether you're going to a doctor's office, a hospital, a rehabilitation facility, a nursing home, wherever that care is being given, a testing facility. There are specific stories that are pertinent to those being in those settings. The second thing is that those questions are also there for you to use in those by setting. And then the thirdly, there are linkable resources, especially if you get the E version of the book, it has that very easily to link straight to those resources. One of those resources is again, how do I become more engaged as a patient? Where can I find that information? There's information about how you could actually go in and be able to rate the performance. It's publicly available information on hospital compare.gov where you can actually rate your local hospitals on their infection rates, on their falls rates, on their patient experience scores.

I want to see a lot more online patient rating. I see when, or you know, when. When you look at various healthcare providers, you see very little about them on Yelp. There are these sort of obscure websites, maybe like the one you mentioned, the government one, you know, that probably not that many people use, you know, why are they on Yelp, for example, or mainstream things that people are using constantly?

I think that's an opportunity, Jason. Clearly an opportunity. I think we're at that first level of transparency about getting this data out. Websites like Health grades are for the doc, you know, for doctors. You can look at your doctor's performance on health grades. There's another website called leapfrog. Leapfrog has actually a very simple. It's called the patient patient safety grade for hospitals. And it's easier for consumers to understand the grade that their local hospital gets A, B, C, D, E and F. So I think that it's coming. I think you're right though. There's plenty of opportunity for the sort of a rating system that would be more in line with, say, TripAdvisor about how you could rate your local hospital, your clinic, clinic, or even your Dr.

Steven, give out your website.

Our website for the book is the patientsurvivalhandbook.com and you can also reach the book on Amazon. It's also our website is for you can also see us on Sinensis S Y N E N S I s Health H E a l t h.com and you can also see more about the book about what we're trying to do to, to in fact bring about and change healthcare to become more safe and patient centered and so and join us. You know, and I think we need patients and families as consumers to really get involved in improving safety and quality in our hospital and our healthcare system.

Yeah, we need a lot more people talking about this issue.

Yes, we do.

It's just, you just don't hear about it. It's, it's so rare that you see a news story about this subject and it is a huge issue that is largely being just ignored or if not covered up. Steve Powell, thank you so much for joining us.

Thank you, Jason. I really appreciate it.

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