Evolution of quality and patient safety in Israel.

We arrived on the ward in the morning and heard the senior physician say: 'We need to draw blood from this patient, but because he has no veins in his hands we will need to find another place, perhaps the neck?' One of us approached the patient and drew blood from the jugular vein; he wanted to use a venous clamp to aid him, intending to tie it around the patient's neck. Another patient post prostate surgery had a catheter in his urinary tract. He called the nurse and complained about severe burning in his penis. The nurse calmed him down and immediately brought an antacid solution, with which she irrigated the urinary catheter. 'The burning in the urinary tract will now pass and you will feel better' assured the nurse. Thirty years ago these anecdotes and many others were told by us, hospital residents, as popular stories, at social gatherings. There was awareness about patient safety, but when it came to errors in treatments or in administering medications, we dealt with the subject jovially and with a sense of humor, without a need for full, organized reporting. In those days, we believed that physician safety took precedence over patient safety and that there was no real connection between quality of medicine and patient safety. We learned, and we taught the next generation, that for example, liver biopsies needed to be performed before noon because if the biopsy was performed in the afternoon and complications ensued, not all of the needed staff would be present at this time of the day in the hospital. We as physicians might then find ourselves in a situation, where we would endanger our license as well as the patient's life. Then, we were also not meticulous in providing the patient with accurate and complete information with regard to surgical procedures, and drug treatment regimens and their possible outcomes. A patient following cataract surgery was required to lie in bed for several days without moving; when during evening rounds he complained of constipation, a suppository was prescribed. We did not explain to him what he was suppose to do with the suppository. In the morning, we removed the bandage from his operated eye and found the suppository stuck under his bandage. It was customary to investigate anomalous cases via ad hoc investigative committees. The members of the committee were senior physicians, who interviewed those involved, …