A government-commissioned inquiry by Sir Robert Francis revealed how these circumstances combined to create a major health care scandal.4 Francis\u2019s report describes how Mid-Staffordshire\u2019s leaders imposed cuts without assessing risks, then intimidated staff into suppressing their concerns. Overwhelmed clinicians, Francis concluded, couldn\u2019t remain conscientious and still keep up. Receptionists performed emergency department triage. Meals were left out of reach of bedridden patients. Drug doses were missed. Incontinent patients weren\u2019t cleaned. And impossibility engendered emotional disconnection. One physician told Francis, \u201cWhat happens is you become immune to the sound of pain\u201d \u2014 or \u201cyou walk away. You cannot . . . continue to want to do the best you possibly can when the system says no to you.\u201d<\/p>\n Meanwhile, management insisted that NHS performance targets be met, punishing breaches even when compliance did more harm than good. Emergency department nurses told of delaying the start of antibiotics, pain medication, and other needed treatment to attend to less-needy patients within the 4-hour wait-time limit. Staff who missed targets feared being fired. This fear, Francis found, led to premature discharges and falsification of records.<\/em><\/p>\n \ncaregivers will move from frustration to insensitivity to corruption when put in an impossible bind between demands for frugality and demands for excellence.\n<\/p><\/blockquote>\n A bit further on we get to the really interesting quote:<\/p>\n \u201cThere\u2019s a defined pot of money,\u201d Francis told me last year. \u201cBut there\u2019s a public expectation \u2014 there\u2019s also a professional expectation \u2014 I should be allowed to do everything that\u2019s in my patient\u2019s interest . . . . Politicians promise the same. When that doesn\u2019t work, it\u2019s the fault of the [institution\u2019s] leadership.\u201d The result is a \u201ctoxic atmosphere\u201d that \u201cprevents those who are running the show from telling the truth\u201d \u2014 and signals caregivers to keep quiet.<\/p>\n This analysis doesn\u2019t let clinicians off the hook for dishonesty or neglect. But it underscores that these scandals are sentinel events \u2014 indicators of the risk that caregivers will move from frustration to insensitivity to corruption when put in an impossible bind between demands for frugality and demands for excellence.<\/em><\/p>\n Filed under \u201cReflections of the Fall\u201d.<\/body><\/p>\n","protected":false},"excerpt":{"rendered":" It appears that the British health system and the U.S. Veterans Administration, have been plagued with the same kind of institutional corruption. The venerable New England Journal of Medicine printed an editorial entitled \u201cScandal as a sentinel event: Recognizing Hidden Cost\u2013Quality Trade-offs.\u201d A government-commissioned inquiry by Sir Robert Francis revealed how these circumstances combined to […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[47],"tags":[425,423,424],"class_list":["post-876","post","type-post","status-publish","format-standard","hentry","category-reflections-of-the-fall","tag-british-national-health-system","tag-scandal","tag-veterans-affairs-medical-centers"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/posts\/876","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/comments?post=876"}],"version-history":[{"count":1,"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/posts\/876\/revisions"}],"predecessor-version":[{"id":882,"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/posts\/876\/revisions\/882"}],"wp:attachment":[{"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/media?parent=876"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/categories?post=876"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/theundergroundchurch.net\/blog\/wp-json\/wp\/v2\/tags?post=876"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}