HLM: Why don't doctors and hospitals do this? Is it fear? Or ignorance? Or lack of resources?
LL: That's not a simple answer. Let's put it this way, the consequences of not having safe care are fairly minimal. It's the patients who get hurt, not the hospitals and doctors. There are occasional people who get sued for gross negligence, but that's a tiny fraction, so hospitals can continue to fail to do things we know make a difference because we know there are no consequences [to them].
Here are two areas where the evidence is good that there's no question we should do it: disinfecting your hands and requiring people to have immunization against influenza. But we have no mechanism for making that happen. If a hospital doesn't require it, nothing happens, and that's not right. It should be illegal.
HLM: Do you think that part of the problem has to do with skill levels and training? That providers don't have the necessary skills to be safer?
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.