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No Excuses: The Reality That Demands Action

Denham, Charles MD; Bagian, James MD, PE; Daley, Jennifer MD; Edgman-Levitan, Susan PA; Gelinas, Lillee RN, MSN; O'Leary, Dennis MD; Sheridan, Sue MIM, MBA; Wachter, Robert MD

doi: 10.1097/01.jps.0000183854.29928.4d
Conference Proceedings

At least six excuses sabotage dramatic improvement in hospital safety. Sometimes they are voiced, but more often they are the elephants in the room, representing barriers to action that no one wants to recognize. They are ever present in hospitals across the country and the excuses they embody include: (1) the business case; the pure economic return on investment (ROI), often argued by CFOs; (2) the evidence for action excuse-that there is not enough compelling evidence to act immediately; (3) the capacity and resources excuse-that balancing act of operations and resource allocation; (4) the absence of leadership and values, when our leaders fail to live the values of the organization; (5) power and autonomy excuses, those hierarchical issues inside an organization and secondly, the power dynamic between those inside and doctors outside who do not work for the hospital; and lastly (6) disclosure fear-that the disclosure of errors to patients and families will increase malpractice claims and public shame.

From the *Texas Medical Institute of Technology, Austin, Texas; †Veterans Health Administration, VA National Center for Patient Safety, Ann Arbor, Michigan; ‡Office of Clinical Quality, Tenant Health Care, Dallas, Texas; §John D. Stoeckle Center for Primary Care Innovation, Massachusetts General Hospital, Boston, Massachusetts; ¶VHA Inc., Irving, Texas; ∥Joint Commission on Accreditation of Healthcare Organizations, Chicago, Illinois; #Consumers Advancing Patient Safety, Eagle, Idaho; and **University of California Medical Center, San Francisco, California.

Funding support for this session was provided by Texas Medical Institute of Technology (TMIT).

Correspondence: Charles R. Denham, MD, Chairman, TMIT, 3011 North Inter-regional Highway-35, Austin, TX 78722 (e-mail:

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