Hospital Or Afghanistan?

The Silent Slaughter of Americans ...

A recent Johns Hopkins study claims more than 250,000 people in the U.S. die every year from medical errors. Other reports claim the numbers to be as high as 440,000. Medical errors are the third-leading cause of death after heart disease and cancer. Add to this that about one in ten who enter the US healthcare system are harmed in some way and we have an undeclared war going on between the system and those it is chartered to serve.

We all know that being an American in Afghanistan is dangerous. In fact, approximately 5000 military and civilian personnel have been killed in Afghanistan over the 17 years of the war or about 294 people per year. While the number of Americans in Afghanistan has varied greatly from year to year, I’m sure that as a percentage of deaths and injuries, being in the US healthcare system is much more dangerous than being in this war zone.

The reason I make this comparison is to point out that, while we take any death in Afghanistan seriously, we don’t seem to care as much about the “slaughter” that is going on every day in our healthcare system. Worse, we don’t seem to know what to do about a problem that is killing and injuring millions of us every year.

The Power of Systems

Here is a little fact that I believe has escaped most leaders, managers, and frontline staff in healthcare.

Fact: Approximately 94% of the outcomes we experience in healthcare, both good and poor, are a function of the systems/processes in which healthcare is delivered, not the efforts of care providers.

The vast majority of deaths and injuries we experience in healthcare are systems based. If we want to change these outcomes and significantly reduce deaths and injuries due to “medical errors,” we have to change the systems, especially where care is delivered.

Almost all healthcare organizations have some sort of quality, safety, or other improvement programs. Hospitals crow about how well they are doing compared to other hospitals. I’d ask, is there a difference in being excellent or being marginally better than other poor performers. Yes, a big difference.

Whatever most hospitals are doing to improve outcomes isn’t working. When things don’t work, most healthcare organizations default to what I call More-Better-Different. They do more of what is not working. They try to do better what is not working. They try to do what is not working differently. It’s time healthcare got out of its own way and re-created its legacy systems that are the source of this needless death and suffering of millions of Americans.

I’ve written a little book on this subject for any who want to explore what I believe is a better model for leadership, management, and transformation of the US healthcare system. Let me know and I’m happy to send you one. 


David Dibble
David Dibble
As a 24-year-old, I founded a company with $5000 and built it into a $10M business with 200 employees. I was an early adaptor in the quality movements of the late 1970s and early 1980s, often speaking to business groups on the subject. Since 1990, I’ve been doing consulting and training, teaching leaders and managers how to be better in their roles, resulting in much higher performing businesses. My life’s work is embodied in The New Agreements for Leaders training, a systems-based paradigm shifting leadership and management model that creates significantly more value in businesses than traditional models. My latest book (I’ve written five) is The New Agreements for Leaders. The engine for implementation of this model is the 7 Tools for emerging leaders and managers. Importantly, the use of 7 New Agreements Tools for leaders and managers actually grows good and even great leaders and managers. For eight years, I worked directly with don Miguel Ruiz, author of the best selling The Four Agreements and prior to that studied both the physical science of change and the spiritual science of transformation. I’m now living in Napa with Linda, my wife of 46 years, so we can be close to our children and grandchildren. I’m learning to drink wine out of a glass rather than a pitcher and still enjoy a bad round of golf now and again.

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