Listen to patients first

In April 2006 one of the largest hospitals in the Netherlands hit the national headlines with the exposure of “scandalously” poor results for cardiac surgery.1 It was a sentinel event for Radboud University Medical Centre in Nijmegen, and parallels were drawn with a similar scandal in the UK at Bristol Royal Infirmary in 2001.2 An investigation found death rates were close to three times the national average and ordered the (temporary) closure of Radboud’s cardiothoracic centre.1

The problem was seen, senior staff freely admit, as symptomatic of a wider malaise in a hospital that paid too little attention to the quality and outcome of care and failed to openly discuss problems.

A new chief executive, Emile Lohman, was brought in. One of the first things he did was to fire all the heads of department and audit each unit’s performance. The heads were then invited to re-apply for their posts. Over a third failed to regain them.

“It was a terrible time,” recalls Hub Wollersheim, a general physician and senior researcher at Radboud’s Scientific Institute for Quality of Healthcare. “The exposure of such high death rates and the suffering of patients and families bought a sense of shame which pervaded the whole hospital.”

The heads of department were then made responsible for improving and maintaining the quality of care as well as its costs and for the quality of training and education. Lohman also stripped out a tier of management between them and the hospital’s executive board, and in 2007 appointed a new chief medical officer, Melvin Samsom, a gastroenterologist with a strong research background, to drive quality improvement.