Patient safety: Jeopardized by competition in the healthcare industry?

Interview with Dr. Günther Jonitz, President of the German Medical Association Berlin


The actual purpose of hospitals and medical practices is to make people healthy again. It’s no secret that this doesn't always happen and that patients can be harmed by treatments. Cost-saving measures in the health care sector pose an especially great danger. Ultimately, however, things can also be different - if policy-makers participate.

Image: Man talking at lecture; Copyright: beta-web/Wart

Dr. Günther Jonitz; ©beta-web/Wart

Yesterday at the MEDICA 2016, a roundtable discussion at the MEDICA ECON FORUM addressed the issue of "Patient Safety in Hospitals". spoke with Dr. Günther Jonitz about this topic, who gave the keynote speech.

Dr. Jonitz, examination and treatment processes are becoming ever more complex. How does this affect patient safety?

Dr. Günther Jonitz: Today, diseases are treated with various sophisticated methods thanks to medical progress. The increasing complexity of procedures for increasingly more challenging and sicker patients makes it more difficult to ensure optimal care and avoid mistakes. Having said that, progress has also resulted in medicine itself becoming more specialized. The more medical disciplines and specialists are treating a patient, the more coordination is necessary. Handling these interfaces is a complex process. Generally, physicians are not adequately trained in this. At the same time, the general framework and time physicians actually need to have the necessary conversations are lacking.

What risks do patients face in hospitals?

Jonitz: Hospitals are under extreme financial and competitive pressure. This pressure is passed on to patients via physicians and nursing staff. There is no other country in Europe where a single caregiver or sole hospital physician is in charge of treating more patients than in Germany. We also notice that young physicians receive less and less guidance and instruction. That means, their continuing education to become medical specialists suffers tremendously. If there is an increasing shortage of well-trained physicians, it will have an impact on the quality of care in the intermediate and long term.

Actual risks in hospitals affect hygiene for example because time pressure also increases the likelihood that necessary measures like hand hygiene are practiced less diligently between patient contacts. Undoubtedly, the individual and psychological support of patients all the way to transitioning to outpatient or rehabilitation settings also suffers given time pressures.

What measures would be needed to ensure patient safety?

Jonitz: In a nutshell, people heal people, not processes and technical systems. That is to say, the general conditions need to be right to make safe actions possible. Technical tools only help in a limited way in this case. Understaffing and an overworked staff create safety gaps; once multiple gaps add up, patients are at risk. We need more staff right at the bedside and in patient care. This staff needs more time to discuss what measures are needed and which ones can be eliminated.

There also needs to be a safety-conscious environment that promotes trust and prevents fear. It is crucial for patient safety to be able to openly point out things that are not running smoothly. This is a key aspect! You also should be able to specifically point out instances where things went wrong but the patient was not harmed. A climate of fear prevents open debate and discussion and learning from near miss events. The management of the respective facility is responsible for the creation of a positive and constructive environment.

What changes are urgently needed in the health care system to achieve improved patient safety?

Jonitz: We need a fundamental strategic policy change here in Germany. About 20 years ago, it triggered a purely profit-oriented competition in health care that exerts pressure on healthcare providers, the healthcare profession, hospital operators and health insurance companies: you only survive if you make a profit. But this type of competition puts the quality of patient care at risk and undermines confidence in the overall system.

Instead of decimating service providers, we need to improve the level of care. To do this, policy-makers first need to identify and address what the optimal care for certain areas looks like. After all, care provision of people takes places locally by people and for people – and not consistently by panels at the federal level. As long as policy-makers set the wrong incentives, we won’t be able to achieve fundamental changes with well-intentioned but relatively ineffective and inefficient mechanisms and tools.

The interview was conducted by Nicole Kaufmann and translated from German by Elena O'Meara.