The difference between the almost right word & the right
word is really a large matter – it's the difference between
the lightning bug and the lightning.

Mark Twain

November 2, 2014

Chest-thumping in Dallas

CDC director Tom Frieden took heavy criticism in the media for saying, on September 30, almost any hospital in the country could take care of Ebola patients, and there was no need to transfer the Liberian patient from Texas Health Presbyterian Hospital Dallas.

But within a matter of days, CDC abandoned that position and said from now on it would send its own healthcare team to assist with and supervise care of Ebola patients anywhere in the country. CDC also initiated to the NIH and Emory the transfer of two Dallas nurses who became infected in caring for the Liberian patient. In effect, the agency and the nation concluded the Dallas hospital could not take care of its own nurses.

One can hardly blame Dr. Frieden for his initial optimism. Hospitals everywhere claim to have world-class or state-of-the-art services and officials at the 898-bed Dallas hospital had exuded confidence in declaring they were ready for all contingencies. Hospital epidemiologist Dr. Edward Goodman said in a media briefing on September 30 “we have had a plan in place for some time now in the event of a patient presenting with possible Ebola. Because of that we were well prepared to deal with this crisis.” Indeed.

The Dallas hospital is one of 23 facilities that comprise the Texas Health Resources delivery system. It turns out the delivery system’s default posture is one of confidence and swagger. On its website, Texas Health Resources claims to provide “world class” services in cancer, neuroscience, scoliosis, and digestive health services.

No evidence is offered for these grandiose claims and, according to U.S. News & World Report, none of the delivery system’s facilities are ranked in the top 50 in the country in cancer or neurosciences or digestive health services (the publication does not rank scoliosis treatment). U.S. News, which lists hospitals annually, overall ranks Presbyterian Dallas as the 5th best hospital in the Dallas - Fort Worth area.

When Britt Berrett, the former president of the Presbyterian hospital announced earlier in the year he would leave on August, 1 the memo sent to employees noted “Britt has set a visionary standard for excellence and as a leader he is innovative, motivating and focused (my emphasis).”

A few weeks later, this is how hospital nurse Briana Aguirre described the hospital’s visionary readiness when faced with its Ebola patient. “It was just a little chaotic scene. Our infectious disease department was contacted to ask, what is our protocol. And their answer was, we don’t know. We’re going to have to call you back,” she said on NBC Today.

Inflated language and exaggerated claims are widespread in the healthcare industry. More than 100 healthcare organizations in the U.S. claim to provide world-class medical care, noted Dr. Kenneth Kizer in a 2010 essay in the American Journal of Medical Quality. “In most such instances, this has been a self-designation made on the basis of unspecified criteria,” wrote Dr. Kizer, a professor at the University of California, Davis health system.

Whereas most Americans probably associate world-class healthcare only with nationally known institutions such as Johns Hopkins or Duke or Massachusetts General, among others, it turns out we have quite a few diamonds in the rough. Take Elkhart General Hospital and Memorial Hospital of South Bend, Indiana for instance.

Together they comprise Beacon Health System, which is “providing world-class care throughout North Central Indiana and Southwestern Michigan,” according to the system’s website. In the same spirit, Cooper University Health Care, the clinical campus of Cooper Medical School of Rowan University, boasts it is providing “world class care. Right here. Right now,” in southern New Jersey.

West Shore Hospital in Mechanicsburg, PA, is also pleased to note residents of West Shore have access to “world-class care.” Meanwhile, Ochsner St. Anne in Louisiana, says it offers “world-class care” in the Bayou Region. Inova Alexandria Hospital in Virginia is hard at work providing “world-class medical care” for patients ranging from “babies to seniors.”

Looking for grandiloquent claims in healthcare is like looking for hay in a haystack. It took only one Ebola patient to shake up U.S. healthcare because his care exposed the chasm between rhetoric and reality.