Scandal as a Sentinel Event — Recognizing Hidden Cost–Quality Trade-offs

N Engl J Med 2016; 374:1001-1003March 17, 2016DOI: 10.1056/NEJMp1502629
Author: M. Gregg Bloche, M.D., J.D.
“In 2014, Americans reacted with outrage to reports that personnel at Veterans Health Administration (VA) medical centers had schemed to feign compliance with targeted waiting times for appointments. Whistle-blowers outed miscreants, alleging that clinical delays had caused scores of avoidable deaths. …The prevailing narrative was one of breakdowns of character and culture: dishonesty, callousness, and ineptitude. Several years earlier, a similar scenario played out in Britain’s National Health Service (NHS), which had set waiting-time and quality-of-care targets that many facilities struggled to meet. The struggles of one facility, in the county of Staffordshire, became a scandal. …As with the VA scandal, politicians blamed individual perpetrators and one another, and the prevailing narrative highlighted lapses of character and culture.”
Find article here. See also “Beyond the VA Crisis — Becoming a High-Performance Network” (N Engl J Med 2016; 374:1003-1005 March 17, 2016DOI: 10.1056/NEJMp1600307).