Infographic – The Hazards of Hospitals


Some people might find this graphic inflammatory, if they are feeling defensive about the state of healthcare and if they feel like they are being blamed personally.

The data in this infographic represents the current state, to the best of the ability of researchers to estimate the impact of poor healthcare quality. To improve, we have to recognize the problem.

The title says, “Why US Hospitals Aren't Nearly as Safe as You Think” but there's nothing here pointing the finger of blame at the hardworking, intelligent, caring, well-educated healthcare professions. It's the processes and systems that are broken, not the people. The people can fix this.

The Hazards of Hospitals
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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. Mark,

    Thanks for sharing that infographic. I knew that there was as lot of improvement opportunity within healthcare, but that one “page” is absolutely loaded. Think of how may A3’s could emanate from it?!

    A staff member at a healthcare client adamantly told me once to, “never go to the hospital unless you have no other choice.” Pretty sobering. And yet, we know we can dramatically improve healthcare. It is really a matter of will.

    • “A matter of will” is a good way to put it. Are people willing to admit there is a problem, even if the data and estimates about the amount of harm are imperfect. The scale of the problem far worse than it needs to be.

      Leaders like Paul O’Neill, Dr. Pronovost, Dr. Shannon, Dr. Gawande, the people at ThedaCare, etc. are real leaders in this area. They have great improvement data. Why don’t the improvements spread?

      O’Neill says it is a lack of leadership, you can listen here:

      He’s frustrated. I don’t blame him.

      Even Dr. Shannon seemed a bit frustrated:

  2. My father, who was a doctor specialized in microbiology, made an study in the main hospital in Las Palmas de Gran Canaria (Canary Islands, Spain): the impact of intra-hospitalary infections was more than 60% of patients in all the floors of the hospital, except one, that had a far lower rate. After a little more investigation of the causes of this lower rate, they discovered that in that section all the personnel was used to wash their hands frequently so they didn’t transmit infections from one patient to other…

    I fully believe that the infographic, even when it is terrific, is realistic.

    Thanks for sharing!

  3. The 26% hand washing number in the ICU is horrific. There are many structural barriers to address — easy accessibility of gel dispensers and sinks, making sure people have enough time to do this, supervisors and managers who are looking for the right behavior, etc.

    There was one ICU I saw where there was a big sign asking (telling) visitors to wash their hands. Was there a gel dispenser right under the sign? NO!

    That would really make me worry as a visitor about the hospital’s attention to detail.

  4. I agree with the need to address environmental barriers, but I think (and I’m not related to healthcare more than as a simple patient) that there is a huge need to realize the importance to the personnel. They need to know the terrible impact that has to neglect the simple policies. Sometimes people do not think on these things

    • Yes, there is a role for personal responsibility. But, do healthcare personnel REALLY not know that hand washing is important? I think they do.

      There’s a leadership responsibility to hire people who are properly trained and educated. And there’s an ongoing responsibility to remind people of their obligations and to remove barriers. We need both. But, put educated, responsible, caring people in a bad system and the bad system will almost always win.

      • Sure! It’s almost impossible they don’t know the importance! But its more proable some people don’t think on the importance… It’s not the same to know than to think and to realize and to keep in mind. The important thing here is to be able (thru leadership) to make important things to become culture, habit, routine… Something you don’t need to think about it.

        I work in the IT sector, and it’s very usual to see bad habits in people and if you ask them, they know the impact, but they haven’t the habit… (I hope I can explain the ideas properly in English :-)

        • Yes. I think it’s the role of supervisors, managers, leaders to remind people of the importance. And there are more effective ways to do this than just hanging lots of signs in the workplace.

          • One of the best ways is to go thru common procedures and identify where hand washing should occur. Believe it or not, it is not always clear to staff when contact will be made especially when carrying supplies or making multiple contacts. Just saying wash your hands more is not always helpful. And as others have pointed out, the means to do this must be in the right place.

  5. A good gaphic presentation, though I might quibble with some of the “solutions”.

    On the handwashing topic: In a hectic, high pressure environment, explicit allocation of time for “out of cycle work” is a critical expression of leadership commitment.

    Whether it is handwashing in the ICU or performing operator daily maintenance routines on the assembly line (similar issues, aren’t they?) if people aren’t given time they will tend to rush to the next step? “Enforcement” is not a solution.

  6. To build upon Andrew’s comment, this is a place where SDCA (standardize-do-check-adjust) can be applied. In SDCA, we check to ensure that standards are being followed and whether they are sufficient. When folks don’t follow the standards (i.e. hand washing), we need to ask “Why?”. It may be a behavioral issue, training issue or possibly it’s a pain in the neck to follow – like if there is no time to do it and/or the hand washing station is not conveniently located, etc. In that last situation, PDCA should follow.

    • I would guess it’s not motivation or training but more the trigger.
      Does the reminder happen at the right place in the process and when the reminder does occur is it actionable in the moment.

  7. Now I have more reasons to not visit anyone in the hospital. When My son was in the NICU a few months back we had to wash our hands anytime we went in to see him. The problem was there was hardley any of the soap bars there on a regular basis. I would alway contact someone and let them know but how many just bypassed that step and went in anyway. Not including the number of nurses that walked in andout with out washing. Yes they only touched a chart or pen or pencil but always had me thinking about the next person that touched the same item. Makes me want to change my direction in lean and run to my local hospital and see if I can help.

  8. I don’t know how is the situation in the USA; last week I was in a hospital (you know, I’m not from the healthcare industry) and I saw that in each room, the first thing you saw after opening the door was a gel dispenser, so even visitors (not conscienced, not educated) washed our hands instinctively. May be it is a good approach!

    Another observation is that I got really surprised of the difference betweent US hospitals and european ones in terms of infections! Here (Spain) the healthcare insurance companies put as a value added to their offering the possibility to be treated in a US hospital (as a symbol of high quality)… Marketing always win!

    • There are many definitions of quality, including healthcare. Think of a Lexus and a Corolla. A Lexus has many features and luxuries, you could call that quality. A Corolla might also be considered high quality if it is built well and runs reliably for a long time.

      There seem to be some Lexus procedures and treatments that people will travel from all over the world for, as the U.S. is the place to get some of this Lexus care.

      But the errors and deaths and problems in the infographic seem to be more like not building Corollas properly… Toyota would have a terrible quality reputation if they built great Lexus products, but lousy Corollas.


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