SpecialityUniversity of Iowa, USA

Social complexity, Social mind and Health: Preventable in-Hospital MortalityThis paper examines the issue of complexity in terms of the social, medical and economic factors that influence preventable in-hospital mortality at the moment in which the patient has successfully survived major surgery. At this crucial juncture the patient is either on the road to recovery--or can, due to adverse events, such as hospital born infections, and lack of infection control--contract preventable post-surgery complications that will cost patients their lives due to hospital errors, including medical neglect. I understand the fatal outcome of hospital errors and medical neglect as preventable crucial events that, if appropriately addressed, can enable the survival of the patient. At what point in the post-surgery treatment is there a radical break-down and failure of criticality--assuming that criticality in a hospital system would enable social, medical and economic components to interact cooperatively and in integrative ways as to prevent hospital errors and enable patient survival. Such an analysis of the failure of criticality ought to include the organizational structure of post-surgery care, especially the resistance of the medical care providers (physicians, nurses) to listen to patients' specific medical needs and to ensure quality control. This involves the uncomfortable question of physicians' investment into their own social structure, hierarchy and authority, which blinds them to life-saving aspects of patient care that they neglect in order to posture--to their colleagues, the patients and their families--a command of medical knowledge that is at best tenuous and is often directly at odds and in conflict with the patient's actual medical needs. How can criticality in the hospital care system be restored in ways that prevent adverse events and medical errors to ensure patient survival? To reverse this trend and ensure patient safety, integration and alignment of the various social, economic, medical risk factors of in-patient mortality would be required, including LOS (length-of stay), lack of investment in hospital resources often informed by age bias, lack of infection control, social risk factors of physician behavior that translate into medical errors.