• Patient safety, quality care and the nurses strike • Zoning in need of enforcement • Mourning the bougainvillea Patient safety, quality care and the nurses strike Safety concerns in hospitals rose to national attention in the year 2000 when
• Patient safety, quality care and the nurses strike
• Zoning in need of enforcement
• Mourning the bougainvillea
Patient safety, quality care and the nurses strike
Safety concerns in hospitals rose to national attention in the year 2000 when the Institute of Medicine, a prestigious unbiased national body of scientists, reported on the unusually high incidence of “adverse events” that occur in our nation’s hospitals. In their publication, To ERR is Human: Building a Safer Health System, the authors estimated that there may be as many as 44,000 people in the United States that die annually from medical errors, which would rank medical misadventures higher as a cause of death than traffic accidents, breast cancer or AIDS.
Since this publication, a variety of factors have been identified as causes of these errors. Most important is the fact that about 90 percent of mistakes can be related to a failure of the hospital system and not the individual. Thus, those responsible for operating systems within a healthcare organization, such as Hawaiian Pacific Health and Wilcox Hospital, must take responsibility for integrating care and setting standards for patient outcomes.
Over the past several weeks we have heard from Wilcox spokespersons and supporters that the “hospital is safe,” despite the contention by the striking nurses that bedside staffing is often inadequate. Who, other than the nurses, can best determine how to provide the highest level of care and patient safety? Nurses are the key individuals to evaluate staffing needs. As Lewis Thomas, a respected physician and medical essayist noted, hospitals are “held together, glued together, and able to function as an organism by nurses and nobody else.”
A variety of metrics have been developed to quantitate safety and quality of care; these include hospital infection rates, frequency of adverse events, wound infection rates following operations, complications following procedures, length of stay for various illnesses, readmission rates, cost of services and patient satisfaction scores. Unfortunately, this data has not been forthcoming from administrators in response to The Garden Island reporters or in HPH newspaper advertisements. Furthermore, this data, which determines the soundness of the patient care system, is not listed on Internet sites that evaluate the performance and quality of hospitals. The public should be able to review this information. The number of personnel and the budget that is now being directed toward patient safety at Wilcox should be made available and be transparent to the Kaua‘i community. At the very least, state regulators and the governing board of the hospital should compare these results with hospitals of comparable size in the United States.
A cautionary note: patient safety depends on the hospital as a system working in a coordinated manner. This process tends to break down during times of stress or when outsiders are imposed into a new work situation. As emphasized by others in The Garden Island and confirmed by studies of other institutions facing similar situations, the present environment at Wilcox may be suboptimal and prone to increased errors. Those individuals seeking elective and semi-elective procedures or operations may want to defer their care or explore care at other institutions until the present situation at Wilcox Hospital becomes resolved and more stable.
The nurses of Kaua‘i are representing all of us, the residents of this island and our visitors. They are insisting that a high standard of care and patient safety be provided at the island’s only major hospital. HPH does not appear to be negotiating in good faith as noted in their proposal that LPNs be eliminated and raises be delayed for one year. They should instead be focusing on patient safety issues and revealing their relevant outcome statistics. Only by resolving the nurses’ concerns on patient safety and providing a solid system of care, can Wilcox Hospital regain its past credibility and work to provide improved medical care for the island’s residents and visitors.
Emeritus Professor of Surgery, Harvard Medical School
Kilauea
Zoning in need of enforcement
I just read the op-ed written by Barbara Elmore (The Garden Island, Aug. 5, “Zoning limits property rights”) concerning the lack of enforcement of zoning laws.
There is not one person in public office on this island that has the intestinal fortitude to stand up and say what she just said.
We have a dire need for someone to enforce the laws and ordinances already on the books and since our currently elected officials won’t do it, won’t you please run for the office of mayor or county council?
This island needs people like you Barbara … you have my vote already.
- Kay Obloy
Wailua Homesteads
Mourning the bougainvillea
They are fallen warriors, now assigned to unknown graves. One day these warriors of beauty and goodness stood at their posts as they had done for years on end. The next they were gone.
They demanded nothing of us, not wages, not shelter, not even food. They were friends of nature and nature took care of them.
Who will remember them now? We know not where they are buried. We, some of us, rather many of us who benefited, recall the blessing of riotous color they gave us. Red, pink, yellow, purple, orange when, by divine instinct, they answered the prompting of the seasons. Was this the crime they were accused of and for which they died?
Their posts empty; left like scars on an abstract painting whose form still remains intact. Those who wait at the bus stop stare unbelievingly. The tourists who took pictures beneath their arbor like branches will not recognize the spots as the same ones they took home with them in their photo albums from their vacation on Kaua‘i.
We, many of us, mourn the absence of the bougainvillea gateway that was meant mostly for those who live on the Garden Island. Now our hearts are taxed beyond repair.
In a parking lot in the center of the government, cultural and business district lived one generation of our bloodline. We will not be able to grow a substitute of a like spirit of self-giving, unless we ourselves are willing to help nature nurture nature.
