There’s a New Leading Cause of Death in Town
If you aren’t concerned about being treated in a hospital you should be. Every day over one thousand U.S. hospital patients die and many more are harmed by the medical care they receive, leading to at least 400,000 needless deaths. If you don’t relate well to statistics, this means that medical errors are now the third leading cause of death in the United States—far ahead of deaths due to auto accidents, diabetes, and everything else except cancer and heart disease.
As healthcare leader Leah Binder describes it, these numbers mean “hospitals are killing off the equivalent of the entire population of Atlanta one year, Miami the next, then moving to Oakland, and on and on. The equivalent of four Vietnam Memorials would need to be built each year to capture the names of U.S. hospital patients who die as a result of healthcare-induced harm.
Medical care has become incredibly sophisticated as well as overwhelmingly complicated and fractured. That’s why medical mistakes are now an every-day occurrence.
You’re Never Far from a Terrible Medical Mistake
We aren’t talking about people dying from illnesses that caused them to seek care in the first place. We are also not talking about complications that result from procedures where known risks are perceived as worthwhile compared to the likely outcome if the procedure is not performed. Patient safety events refer to wrongful events of healthcare-induced harm. These events are not due to breakdowns in complex medical decision-making or the lack of access to care.
Most often, patient safety events involve basic human error—especially errors of omission. As Megan McArdle, author of The Upside of Down, notes: “None of us is ever very far from a terrible medical mistake.” So, what does a terrible medical mistake look like?
It is the mother-to-be who had the wrong embryo transplanted into her womb because the in vitro clinic didn’t use the universally approved preoperative checklist, leaving the mother to cope with a court order to share custody of the child with a complete stranger—the man whose sperm was used to create the embryo that grew to be her baby.
It is the newborn whose heart stops after receiving a medication dose that was calculated for an adult because an overworked pharmacist made a mistake and a nurse did not double check the order before injecting the drug into the baby’s IV.
Every single day, basic human and system errors kill 1,000 hospital patients and cause serious harm to another 10,000 to 20,000. Nobody is immune—not doctors, nurses, or hospital CEOs. The fallout from basic human and system error strikes newborn babies, pregnant mothers, and the elderly. It has happened to me and it could happen to you.
The Underreported Disaster and Its Untapped Resource
In an average week more patients will die from the medical care they receive in US hospitals than the total number of people who died in natural disasters between 2005 and 2015, including Hurricane Katrina and the massive earthquakes in Nepal. While hurricanes, tsunamis, earthquakes and other natural disasters make national news and receive round-the-clock coverage, the patient safety death toll climbs week after week with scant media attention or public awareness.
Along with the press coverage of natural disasters comes thousands of people who freely give their time, talent, and resources to help stabilize the situation and heal the afflicted. If the American public understood the magnitude of the patient safety crisis and had a clear idea of how they could make hospitals safer, they would offer a helping hand. But here’s the rub: even if the public stepped up to help, healthcare workers aren’t prepared to accept their help.
If the best clinicians, scientists, regulators, and policymakers working in tandem haven’t been able to solve this problem, why should anyone expect the solution to depend on getting the general public involved? After all, we are talking about a vexing problem that occurs during the course of complex clinical care within an industry that operates at a rapid pace, under the toll of extensive regulation, and in the midst of a constantly changing knowledge base. So, you might wonder, why complicate the problem by getting the general public involved?
The truth is that the general public cannot solve the patient safety crisis on its own any more than hospitals can. Radically improving patient safety will require meaningful collaboration—a true partnership—among providers and patients, and between hospitals and the communities they serve. Such collaboration must be the norm; it must not remain a lofty ideal or the exception to the rule. And waiting until patients are hospitalized, or about to be hospitalized, to prepare them for their roles and responsibilities for safe care amounts to too little too late.
Zeroing In For Success
As I discussed in a recent issue of Society (The Hospital Safety Crisis), a fundamental change in our nation’s approach to and assumptions about patient safety is in order. The change must center on engaging patients for the purpose of collaborating with healthcare providers to eliminate a small but powerful subset of patient safety’s most frequently recurring problems.
Laudable as comprehensive quality/safety efforts are for advancing medical science, as organization-wide programs or initiatives designed to improve day-to-day safety at the bedside, they set healthcare workers up for failure, disappointment, and disillusion. Greater return on investment can be realized by focusing on getting providers en masse to exhibit excellent performance around a defined and manageable set of safety habits. Because safety depends on patients being part of the solution, it is all the more important to focus on habits they too can recognize, request, and/or use.
Doing Less to Achieve More
Psychologists who specialize in behavior change know that people are capable of addressing only one or two new behavioral habits or routines at a time. The same holds true for establishing organizational habits.
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In the years since the hospital safety crisis was first publicly exposed (see To Err is Human, 1999), the field of patient safety has identified specific strategies that have the capacity to eliminate the vast majority of hospital deaths due to a handful of issues that, as a group, compromise the majority of all preventable deaths. This group includes healthcare-associated infections (e.g., superbugs like MRSA, pronounced mursa), off-the mark procedures (e.g., surgeries on the wrong person or body part), and medication administration errors.
Strategies to prevent this group of events involve simple, quick, and practically cost-free actions such as use of proper handwashing techniques, checklists, and double-check. Because these events represent the most prevalent, predictable, and preventable types of patient harm, you can think of them as a trifecta of sorts.
The trifecta of preventable infections, procedural mix-ups, and medication mistakes constitute exactly the sort of problems that can be successfully addressed through public awareness and education campaigns.
Our Best Hope for Success
No matter how sophisticated the science of medicine or clinical care delivery systems become, it is an inescapable reality that ensuring patient safety is often a function of forming and sustaining simple safety habits among the millions of nurses, physicians, pharmacists, therapists, support staff, and others who affect the lives of patients every day. The breadth and volume of people who must exhibit safety habits begs for a unified, straightforward, and manageable approach.
The work before us calls for a paradigm that is comprehensible to everyone regardless of rank or role and that unifies efforts of hospitals, public health, and society overall.
To the extent they are capable, providers and consumers of healthcare need to know and exercise their roles and responsibilities for eliminating healthcare’s current trifecta of safety events. Building accountability around the safety habits that can eliminate these recurring serious safety events depends on creating a greater sense that providers are accountable to their patients while also preparing patients to speak up when they observe lapses in their healthcare.
In order to change the behavior of healthcare providers, we must influence the behavior of the patients around them. Whatever reasons have existed for treating hospital safety as an in-house matter, it is time to take this issue to the streets. How ready are you to help protect yourself and others from unnecessary healthcare harm?