It looks at one of the core challenges the American healthcare system faces today, through the lens of interviews with experts across the healthcare spectrum, by exploring solutions to the problem, rather than maliciously exposing the worst-case scenarios of medical malpractice.
How did you select the interview subjects you included in the film?
We were lucky enough to leverage my father’s legacy [Safety pioneer John Eisenberg, MD, director of the Agency for Healthcare Research & Quality (AHRQ) until his death in 2002], which is still strong today. People were more than willing to participate in our film, not only because of the connection to my dad, but also because we approached the subject matter with an earnest effort to seek out solutions, not just focus on the problems. We started with people who worked directly with my father at AHRQ in the late 1990s and branched out from there as the story became more focused.
What role does teamwork play in preventing medical errors?
It’s everything. When I look at health care, I see a baseball field. Every person on that field is responsible for their own area, but they rely on others to be in position to execute any given play. The research is done before a pitch is thrown, but once it’s released, anything can happen. If the players/providers don’t back each other up when an unexpected mistake occurs, the problem becomes much worse. From the janitorial staff all the way to the CEO, it’s vital to achieve a collective understanding that the end goal is to create a safe environment to deliver quality care.
Based on what you’ve learned from making this film, what advice would you offer facility leaders about preventing medical errors?
Give patients a voice and listen to it. There’s often an iron curtain between leadership and their healthcare consumers. Sending a questionnaire three weeks after a surgery isn’t enough. Leaders must find more ways to engage their community and make them feel part of the team. Patients see things you don’t; their opinions are often invaluable.
How can healthcare leaders tap into the power of personal stories?
Invite patients into the conversation. When a person goes to the hospital, it’s a huge moment, and yet for the healthcare professionals, it may just be another patient in a long day. When you listen to the experiences that patients had, especially the negative ones, you can learn where the gaps are in delivering safe care. You can find out what patients see and feel outside of their medical result. For every person that has a traumatic experience in your facility, their family members will all share that pain in one way or another. OSM