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October 2009

Arrowsight Referenced in NEJM Sounding Board Article on Accountability -- by Suzanne Delbanco, Ph.D.

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In this week's New England Journal of Medicine, nationally-recognized patient safety experts Peter Pronovost, MD, Ph.D. and Robert Wachter, MD argue that the "no blame" approach to improving patient safety needs to be balanced with accountability.  While refraining from blaming individual health care workers for making preventable medical mistakes makes them feel more comfortable to report mistakes, it may not be enough to propel forward efforts to improve care that are stalled.

Citing poor hand hygiene practices as an example, the authors review the structural changes and information campaigns that hospitals have implemented and conclude that they have not done enough to bring hand hygiene compliance to an acceptable level.  What's left to do? Hold health care workers accountable when they fail to adhere to patient safety practices known to protect patients from adverse outcomes.

There are certainly different ways to assess how well workers comply with critical protocols as well as myriad ways to hold them accountable.  But the authors highlight, in the case of hand hygiene, that one prerequisite is to have in place a fair and transparent auditing system of which clinicians are made well aware.  By way of footnote, Arrowsight is referenced as providing one methodology - video - that can be used both to measure and to provide feedback to clinicians.  Pronovost and Wachter cite the fact that meatpacking plants use remote video to hold workers accountable for performance (also Arrowsight's work) -- isn't it time we offer the same protection to patients?

Suzanne Delbanco is President, Health Care Division, Arrowsight, Inc.

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