Putting the Burden on Patients?


I saw this ad (click on the photo for a larger, readable view) in the Wall Street Journal Monday. It's an ad run by a patient advocacy organization called “RID” (Reduce Infection Deaths).

The headline is “15 Steps You Can Take to Reduce Your Risk of Getting an Hospital Infection.”

It's good to make patients aware about safety risks and reasonable precautions they can take to look out for their own safety. However, it's a crying shame that it comes to this… why aren't hospitals being more responsible?

The tips basically put the burden on the shoulders of patients to “inspect” their doctor's work or to tell them what to do, including:

1) Ask that hospital staff clean their hands before treating you

2) Before your doctor uses a stethoscope, ask that the diaphragm (the flat surface) be wiped with alcohol.

9) Ask your doctor about keeping you warm during surgery.

14) If you must have an IV, make sure that it's inserted and removed under clean conditions and changed every 3 to 4 days.

This is ridiculous. Maybe the burden for cleaning the “thingy “on the “doohickey” around the doctor's neck that checks your ticker should be placed on someone who knows what the diaphragm is on the stethoscope without parenthetical explanations.

Do we see this need in other industries? The need to put the burden of safety on the customer?

I can just see it now:

15 Steps You Can Take to Reduce Your Risk of Your Plane Crashing, including:

  1. Carry a handheld Breathalyzer and ask your pilot to blow into it before takeoff.
  2. Ask to see your airline's maintenance records

15 Steps You Can Take to Reduce Your Risk of Your New Car Having Defects, including:

  1. Have the dealer triple check that the wheels' lug nuts have been tightened properly
  2. Ask to see the Statistical Process Control charts that verify that your engine's cylinder bore diameters are within design tolerances.

15 Steps You Can Take to Reduce Your Risk of Your New PC Failing, including:

  1. Make an unannounced trip to the factory and ask that PC assembly operators are wearing proper static-protection wrist bands.
  2. Ensure that the bands and their grounding are properly grounded (press the button labeled “test” on the workstation)

Asking patients to track such details, expecting THEM to know how often an IV should be changed is an outrage. Hospitals and physicians, please quit abdicating your patient safety responsibilities onto the patients. If hospitals were following “standardized work” practices, we wouldn't have to make patients worry about and track issues like this themselves.

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. I wonder if this ad could be a subtle way of applying pressure to the hospital industry…ie, hoping that enough people would raise these issues with doctors and nurses to embarras the medical profession and get them to make changes.

  2. I’d hope it’s embarrassing. Stuff like this has been in the public often enough over the past 10 years at least… and surveys still show, for example, hand washing compliance is horrible. I’m not sure what it will take. It will take leadership from hospitals, that’s for sure. We have to reduce waste so that well-intended employees aren’t pressured into cutting corners (and taking liberties with patient safety). There are many “whys” to ask, rather than just blaming employees (or physicians) that aren’t doing these things. We have to work on the culture and the climate.

  3. This is a great post Mark. Here are some of my suggestions:

    Protect your own health:

    Save on booze by drinking cold tea instead of whisky. The following morning you can create the effects of a hangover by drinking a thimble full of washing up liquid and banging your head repeatedly on the wall.

    Avoid cutting yourself while clumsily slicing vegetables by getting someone else to hold them while you chop away.

    Smokers. Save on matches and lighters, by simply lighting your next cigarette from the butt of your last one.

    Avoid obesity:

    TAKE your dustbin to the supermarket with you so that you can see which items you have recently run out of.

    LOSE weight quickly by eating raw pork or rancid tuna. I found that the subsequent food poisoning/diarrhea enabled me to lose 12 pounds in only 2 days.

    DRILL a one inch diameter hole in your refrigerator door. This will allow you to check that the light goes off when the door is closed.

    Be responsible for your own safety:

    SMELL gas? Locate the suspected leak by striking an ordinary match in every room in the house until a loud explosion reveals the source of the escaping gas.

    WHEN throwing someone a sharp instrument such as a bread knife, always throw it blade first as they invariably tend to turn whilst in the air.

    When driving:

    A TEASPOON placed in a glass on the back seat of your car makes a handy audible gauge for road bump severity.

    AVOID parking tickets by leaving your windscreen wipers turned to ‘fast wipe’ whenever you leave your car parked illegally.

  4. Mark,

    Thanks for posting this. This really HIGHLIGHTS The lack of understanding who the customer is, is it the Hospital (i.e. doctor, nurse, pharmacist, et. al) or is it the actual sick person. Now imagine if we ever do get universal healthcare, if you do not wash your hands you may go to the end of the line, IMHO…

  5. First of all, if we’re ever lucky enough to get universal health care, there will be an appeal process and the medical community will be REQUIRED to tell you in advance what it is. This is standard federal practice.

    Moving on from there, *thank you* for your comments, Lean Blogger. I am extremely sick of being told *I’m* supposed to teach the very person upon whom my life depends (as in “don’t piss this person off”) what their mother should have, their medical school profs should have, their employers should be. How outrageous.


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