The Need for Clean Hospitals


Our Unsanitary Hospitals –

That's “Clean”, not a typo of “Lean.” Good column in the WSJ today by Betsy McCaughey, head of the Committee to Reduce Infection Deaths organization (link).

She asks why restaurants and meat packing plants get inspected more than our nation's operating rooms.

“Restaurants in New York are inspected, without prior notice, once a year. In Los Angeles, inspections are done three times a year, and restaurants must display their grade near the front door. After L.A. instituted this inspection system in 1998, the number of people sickened by food-borne illnesses fell 13%, according to the Journal of Environmental Health. Other cities are now following L.A.'s lead.

Why aren't hospitals held to the same rigorous standard? The consequences of inadequate hygiene are far deadlier in hospitals than in restaurants. The Centers for Disease Control and Prevention estimate that 2,500 people die each year after picking up a food-borne illness in a restaurant or prepared food store. Forty times that number — 100,000 people — die each year, according to the CDC, from infections contracted in health-care facilities.”

What leads to infections? Some of it is a classic Lean “standardized work” issue:

These infections are caused largely by unclean hands, inadequately cleaned equipment and contaminated clothing that allow bacteria to spread from patient to patient. In a study released in April, Boston University researchers examining 49 operating rooms at four New England hospitals found that more than half the objects that should have been disinfected were overlooked by cleaners.

Why is this? Lack of training? Lack of clear standardized work? Lack of time to do their job properly?

She then writes:

“Hospitals used to routinely test surfaces for bacteria, but in 1970 the CDC and the American Hospital Association advised them to stop, saying testing was unnecessary. The CDC still adheres to that position despite a 32-fold increase in MRSA infections. CDC officials say that lab capacity should be reserved for tests on patients.

Testing surfaces is so simple and inexpensive that it's used routinely in the food industry. Is it more important to test for bacteria in meat processing plants than in operating rooms?”

If we have lab capacity issues (that testing is done in a hospital lab), there is another opportunity for Lean, to improve flow and to free up capacity. The healthcare industry has smart people and the tools to fix all of these problems, we just need the leadership and the attention to be paid to these issues. The public needs to start standing up and demanding better.

It's not just hospitals, either, it's doctor's offices, which get no inspection at all. McCaughey tells a story of a physician who was REUSING NEEDLES (yes, you read that right) with patients. Who in their right mind does that?

The New York State Department of Health called Dr. Finkelstein's reuse of syringes
a “correctable error,” and is allowing him to continue to practice under observation.

I know I often write about not blaming people, but this is not an “error,” it's a “violation,” which involves choices that doctor is knowingly making. How can he not be held more accountable? The state “regulators” knew, in 2005, the doctor was doing this, but they wouldn't suspend his license. Yeah, the state sure is looking out for you in New York. (another article) It's mindboggling that we'll fire and punish people who make an inadvertant error, but we'll look the other way when a doctor is purposefully and intentionally doing something unsafe. They're having to test patients of his for Hep C and HIV because of his stupidity. Ok, enough of that tangent.

Anyway, the WSJ piece is a good article if you have access to check it out. Rupert Murdoch is most likely going to make the WSJ a free ad supported website in the future, rather than relying on paid subscriptions.

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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. My husband had MRSA, which began on his leg in May. We knew what it was in July, but it took until November to get the doctors to listen, take a culture and actually treat the infection. The scars on his leg are a daily reinforcer of our mistrust of the medical establishment. My own MRSA was never diagnosed or treated and went away on its own. I hope. We were never treated as a unit, despite one doctor’s observation that we were “probably passing the infection back and forth”.

    The last doctor he saw was an infectious disease “specialist”. She poked at his open, suppurating lesions with her gloved finger, then turned around and tapped her findings onto her computer keyboard WITHOUT taking off her gloves!

    I was a zoology major, trained in lab technique, so I knew taking your gloves off before turning away from a patient should be such ingrained behaviour she shouldn’t have been able to *not* do it. She never noticed, even went back and poked some more into his lesions with her now keyboard-contaminated fingers. I almost fainted. My husband, an accountant, had to have all this explained to him.

    After seeing this, I wouldn’t set foot in that group practice’s office, lest Thyphoid Mary had touched something.

    Thank you for your necessary work.


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