LL: Medical schools still emphasize knowledge and try to turn out physicians who know what they are doing, can make a diagnosis, prescribe a treatment and follow through with it, meanwhile ignoring the fact that healthcare is at the heart a teamwork activity. They should be learning teamwork. Some medical schools have begun to do this but the majority still don't.
HLM: Tell me more about the regulatory agency that would compel patient safety in hospitals. What you called the "brute force" option.
LL: I was joking about 'brute force.' What I mean is regulation as opposed to exhortation. This agency would do what the FAA does, which is to say, "Here are all the standards. We expect you to follow them. And we're going to come around and inspect and if you're not doing them, we're going to rap your wrists and expect you to shape up, and really get serious about it."
It's incomprehensible to me that hospitals can continue to not follow practices that are known to make a real difference.
HLM: Could the Centers for Medicare & Medicaid Services be this agency?
LL: No. It would be a separate agency, like the FAA, totally independent of political control. That's not going to happen in the current environment, of course.
HLM: If you're addressing a room full of America's hospital chiefs what would you say to them?
LL: I'd say that whether we become safe depends on them. Safety is a byproduct of a culture in which people take responsibility and feel personally accountable, where it's safe to talk about mistakes, where you know you won't get punished, or someone else won't get punished. It's a leadership issue.
Leape, 82, now teaches quality and safety at Harvard (the class size has doubled in seven years), visits hospitals around the country, and writes papers about changing provider culture to improve quality and respect. "If we can get that, many of these other things will come around."