Physician, astronaut, medical reformer
The next time you are a hospital patient, don't be afraid to ask your visitors to wash their hands before they sit down. And your nurse. Yes, and your doctor, too.
That's the word from Dr. Jim Bagian (pronounced BAY-zhin), director of the VA National Center for Patient Safety, headquartered at Domino's Farms. Bagian is a streak of lightning disguised as a bureaucrat. In the past decade, the former astronaut has made the country's veterans hospital system a global leader in preventing life-threatening medical oversights and errors.
Shortly after Bagian began work as the center's first director in 1999, the Washington, D.C.-based Institute of Medicine published a report on patient safety in hospitals. Its shocking conclusion: "As many as 98,000 people die each year due to medical errors." The estimate was based on the prevalence of everything from inadequate hand washing (which can spread serious, even life-threatening, infection) to rare instances of surgical procedures being performed on the wrong patient.
Bagian says he and his staff looked at the changes in medical protocols recommended by the study-but realized "we were already doing them." They have since pressed far past the report's recommendations to change the VA's medical practice and culture. Under Bagian's leadership, "the VA is probably ahead of almost all hospitals in the world [in patient] safety," says Dr. Drew Gaffney, a fellow astronaut who now oversees patient safety at Vanderbilt University Medical Center. Gaffney says that the protocols Bagian developed at the VA are being copied internationally.
A motorcycle helmet sits on Bagian's desk-he often rides to work from his home in Northville. At fifty-seven, he is trim, casually dressed, and blunt. He rolls his eyes at recent medical jargon like "patient-centered." "What other 'centered' would it be?" he demands. "Income centered? Ego centered?"
Though he finished first in his class at Drexel University in Philadelphia, Bagian scoffs at academic pretensions. His father, a hero World War II fighter pilot, was a pipe fitter in civilian life; his mother
was a secretary. Yet his parents are "as sharp as they come," he says. "My father always says respect is earned. If you're not hardworking, you don't deserve respect."
Bagian says he dreamed about being an astronaut as a kid, but concluded at age twelve that his goal was unrealistic. Instead he earned an engineering degree at Drexel, then stayed in the Philadelphia area for medical school at Thomas Jefferson University. He was a senior medical student when, during a hospital work break, he thumbed through an Air Force Reserve magazine and saw a NASA ad recruiting astronauts. He wrote down the phone number on his scrubs, applied-and was shocked to be accepted.
After training in Texas, he was originally assigned to the doomed Challenger mission in 1986. He survived only because the entire crew was switched to a later flight. In the aftermath of the disaster, Bagian, a trained diver, helped in the grisly task of retrieving the remains of the Challenger's crew.
Bagian went on to fly two shuttle missions. Gaffney, who worked with him on the second, in 1991, recalls Bagian summoning him excitedly to see the Great Lakes and other sights passing below. Bagian's most lasting contribution to the space program was developing a treatment for motion sickness in space. The space program had avoided the issue, but "I rallied the doctors and crew and got them to agree" to advocate for the change, Bagian recalls. Now, astronauts routinely get anti-nausea injections.
Making headway on patient safety was tough at the start. Initially, Bagian recalls, some VA administrators and senior physicians assumed "it's not my problem." The biggest challenge, he says, was ending a "blame game" mentality that made staff reluctant to discuss problems. "If the first question the supervisor asks is, 'Whose fault is it?,' then you're in a bad place," he says. "The question is…what do we do to prevent it from happening again?"
At first, only two out of twenty-two VA networks (there are six to ten hospitals per network) signed on to Bagian's reforms. That quickly changed once the center's work began to show results.
The VA became the largest U.S. hospital system to switch completely to electronic record keeping, reducing errors caused by handwritten charts and prescriptions. Other changes included putting disinfectant dispensers on the walls of patients' rooms and creating computerized "tool kits" that include things like printable checklists and signs to help reduce patient falls. One problematic drug, the topical anesthetic benzocaine, was removed from the entire VA system. "It wasn't like asking a physician, 'Please don't use it,'" Bagian recalls. "It's just not there!"
Judging the results of preventive measures is tricky, but Bagian points to some markers. One study found that the number of patient falls in the VA system had been reduced by 31 percent. Another showed that the incidence of hand washing in patient rooms had almost doubled. What pleases Bagian most, though, is the psychological change. For instance, VA staffers now report "close calls," making it possible to identify problems before a patient is harmed. "They're not worried about getting punished," he says. "And things actually get fixed!"
Bagian has no more respect for social pretensions than he does for academic ones. For years he drove either motorcycles or $700 junkers, believing that spending money on new cars was wasteful. Finally, on his fiftieth birthday, he guiltily bought himself a sporty Subaru WRX. Still, he insisted his four kids learn basic mechanics before he let them take their driver's tests. (His wife, Tandi, is an engineer.)
He's still in the Air Force Reserve, and as a flight surgeon he helped rescue victims during Hurricane Andrew. Yet these days most of his flying is for rounds of meetings and conferences. Doesn't such an action-oriented guy get impatient with endless talk fests? His striking blue eyes narrow at the question.
"If I attend meetings," he replies in a you'd-better-believe-it tone, "they accomplish something."
[Originally published in July, 2009.]