The January 2010 issue of Health Affairs includes an article looking at progress in patient safety in the 10 years since the Institute of Medicine issued its seminal report “To Err is Human” which found that medical errors cause up to 98,000 deaths per year.
The author, Dr. Robert M. Wachter, is associate chair of the Department of Medicine at the University of California, San Francisco and an expert on patient safety. He will also be featured in a free webinar, open to the public, hosted by Modern Healthcare this Wednesday (click to register). Five years ago, Dr. Wachter gave a grade of C+ to the efforts made to improve patient safety in the 5 years since the 1999 report was issued. One decade after “To Err is Human,” he gives patient safety efforts a grade of B-.
He discusses 10 areas on which he gives individual grades. Some of the initiatives that he mentions as having had positive impacts on patient safety progress: government initiatives such as reporting of errors and Medicare’s policy of reducing payment when certain “never events” occur; more focus on learning from errors and not just reporting; research (he specifically mentions checklists) on patient safety improvement initiatives and tools; disclosure of errors to patients and family members; and interventions by national and international organizations such as the World Health Organization, the Institute for Healthcare Improvement, the National Quality Forum, and others.
Some areas in which there has been a lack of progress include: a continued lack of attention to safety in settings outside of hospitals and nursing homes; health IT (though he mentions recent federal investment as a positive development); lack of engagement of medical providers in patient safety; and lack of evidence that engaging patients on helping to prevent medical errors can actually make a difference without making them feel guilty when errors still occur.
Dr. Wachter concludes that unfortunately we will probably be unable to assess progress with hard numbers because a study such as that which informed the IOM report probably will not be repeated due to its cost and complexity. He is optimistic that further progress will occur in the coming decade.
In terms of what is happening in Massachusetts, we are moving ahead in many of these areas. The Department of Public Health is required to publicly report infections and Serious Reportable Events (“never events”) and hospitals are no longer being reimbursed for care needed following the occurrence of preventable Serious Reportable Events (and regulations will be written next year to prohibit reimbursement for care needed following preventable infections). Disclosure of errors has become a more widely accepted practice, though legislation requiring disclosure did not pass during the last legislative session, and more hospitals, though certainly not all hospitals, are using checklists to prevent infections and complications (the Consumer Health Quality Council is advocating for legislation requiring their use). Health IT is moving ahead thanks to Chapter 305 and a working group of the state’s Quality and Cost Council is trying to advance patient safety programs in all settings of care. Finally, as payment reform is implemented, consumers will become engaged in health care in many ways. As medical providers involve patients and family members in decisions about treatment options and in managing chronic diseases, there will be more positive health care outcomes.
-Deborah Wachenheim
