Medical mistakes in Maryland hospitals rose by 5% in fiscal 2023, the state health department reported Sept. 12 in its annual report on the Hospital Patient Safety Program, though it doesn’t explain why it takes more than two years to assemble the data.
Of the 808 most serious level 1 incidents in the report, 49 resulted in the death of the patient. Most of the serious injuries were the results of falls and pressure injuries, such as bedsores. The report attributes some of the rise to the after-effects of the covid pandemic and personnel issues due to staffing shortages and stress.
One thing I did not see mentioned in the report as a cause of medical issues is that perhaps the staff employed at these medical facilities do not always understand what is being asked of them when it comes to patient care, something I personally experienced.
It is certainly a possibility that the English Language is not well understood in these environments. A look at the data shows approximately 50,000 foreign nationals are employed in the Maryland healthcare system. This estimate assembled from AI sources is derived from the most recent available data from 2021. It is calculated based on the U.S. Census Bureau’s American Community Survey, which indicates that 26% of Maryland’s healthcare workers are foreign-born. With roughly 190,000 total healthcare workers in the state (extrapolated from U.S. Bureau of Labor Statistics employment data for healthcare and social assistance sectors, adjusted for 2023 trends showing about 7,400 annual job gains), this yields around 49,400 foreign-born health-care workers.
That same 26% reflects the approximate number of foreign born healthcare workers in the Johns Hopkins hospital in Baltimore. Fully one quarter of the staff may speak English as a second language. I can speak to this issue since it was just over a year ago I was admitted to Hopkins in Baltimore for extensive open heart surgery which led to a 51-day stay in the hospital.
Overall the experience was excellent and I can truly say that I am able to write this piece because of the excellent work and outcome of the entire process. But 51 days does expose you to a lot of staff and the work they perform. My observation across the entire period of time is that there are numbers of staff, nursing assistants, nurses and doctors who do not speak clear and understandable English.
I do not offer this observation as an indictment of these workers. They have all trained hard and have attained a level of medical proficiency in the country they immigrated from. They have been certified to perform medical duties in accordance with U.S. medical practices and for that they are to be commended.
But to be brutally honest some speak English better than others. I can say that on more than one occasion I heard the doctor issue medical instructions that were misinterpreted by the attending staff. When questioned about what the doctor had said and what was about to be administered a follow up check with the doctor avoided a mistake. As they say – no harm no foul – but there could have been because communications were not clearly understood.
In any endeavor clear communications, understood by everyone, is the key to a successful outcome. The need to fill the voids in the health care system in Maryland is clearly understood. However, there is a need to ensure that those foreign workers who are filling the void are able to communicate clearly regarding patient needs as directed by doctors to nurses and nurses to the aides that assist them. Doctors as well need to meet a higher standard of communications when they themselves have received their medical training outside the U.S. and English is their second language.
If Maryland’s Health Department is seeking root causes for medical mistakes I would highly encourage their investigators to consider the impact of communications among foreign-born staff.
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