The findings were troubling and an indication of the kinds of issues facing hospitals worldwide as they seek to infuse medical treatment with a higher level of quality and safety. Thabiso's preliminary topic was to evaluate nurses' understanding of the VAP bundle (designed to reduce the incidence of ventilator associated pneumonia for patients in ICUs.) Not surprisingly, there were differences among the nurses that correlated to their years of experience. The hope, though, would be that the VAP protocol would be uniformly understood and applied regardless of tenure.
More seriously, Thabiso documented that the rate of pneumonia did not correlate to the reported adherence to the VAP bundle in the ICUs. In other words, the staff's documentation that they had carried out the bundle was inaccurate.
In my view, this kind of result is indicative of not only incomplete understanding but also incomplete buy-in by the clinical staff. Ultimately this is derivative of a lack of leadership from "on high" in the organization. Such a phenonemon does not only occur in Africa. I have seen examples throughout the world, including the US.
In a comment to the post below, my regular correspondent "nonlocal MD" noted the poor safety record of some hospitals in Texas:
Interesting concept, and I am not at all surprised about Texas. It again raises the question that you and I debate, Paul - will hospitals do the right thing of their own accord or is it necessary to demand accountability from an outside source? And when you answer with the word 'leadership', I ask then, how will we find those leaders? They seem to be in short supply.
One answer has been given by my colleague Dave Mayer, head of quality and safety at Medstar Health, who jokingly responds: "Educate the young . . . and (when necesaary) regulate the old."
Humor aside, Dave may have the right thought. While trying to infuse quality and safety training into the curriculum of young doctors and nurses, there is likely a need for oversight from regulators or other outside bodies--if for no other reason, than to get the attention of the senior admininstrative and clinical leadership. That being said, unless those senior leaders truly believe in the need for process improvement and act on that belief every day, the horrendous status quo with regard to unnecessary deaths and harm documented by Michael Millenson will continue.