Getting 'skin in the game'

John Taylor: October 15, 20070 Comments

Sometimes it's how you say something -- using a metaphor, an analogy, an anecdote -- that really makes the message have some impact.

The presentation was titled, "Patient Safety: Getting Sustainable Improvement."  Oh, boy. Another Power Point by a government wonk, giving yet another reason to ditch part of a Hospital Council conference and instead stroll the Monterey shoreline.

Turns out Dr. James P. Bagian is a good deal larger than life, for a slightly built anesthesiologist. He's flown into space twice, investigated a shuttle disaster, is a snow-and-ice rescue technique instructor, a free-fall parachutist, a jet/helicopter/prop/glider pilot and an expert in medical safety for the Veterans Administration.

One of his points: Studies show the average hospital patient gets the wrong medicine once out of every 10 times.  Would you fly in a passenger jet with those odds, Bagian asked, or go to a McDonald's with that record of getting your order right?  When he went cross country to visit his ailing mother, Bagian found that she was being given the wrong meds repeatedly despite protesting to the administering nurse. He checked his mother's chart and found glaring omissions.

And one of Bagian's a bit icky, but powerful illustrations:  In an airline crash, the pilot is always the first on the scene. So, when a hospital patient acquires a central line infection (a catheter-related bloodstream infection), Bagian wondered if such lapses might diminish if the attending physician and his family were injected with the patient's germs.  "You need to have skin in the game," he said, to build a culture of quality. It's a bit like ham and eggs -- the chicken is involved but the pig is committed.