In the United States, the cornerstone of the health care delivery system is
the modern-day hospital. Hailed for its ability to save lives and improve the
medical condition of the masses, the hospital is an amalgamation of
technological wonders. At first glance, the system seems like a well-oiled
machine; however, upon further inspection, we find some major flaws, chief
among them medical errors.
In 1999, the Institute of Medicine (IOM) issued its benchmark report
titled To Err Is Human: Building a Safer Health System. The findings of this
report shocked America. The report estimated that upwards of 98,000
people per year in the United States were dying as a
result of preventable medical mistakes. Headlines such as “Medical Errors
Blamed for Many
Deaths; As Many as 98,000 a Year in U.S.” from the Washington Post, or
“Medical Mistakes
8th Top Killer” from USA Today, brought the consequences of medical
errors to the forefront of our attention. The idea that the hospital was the
epitome of health and safety was quickly replaced by a fear of needing
hospital services. In fact, a new phobia entered our vocabulary:
nosocomephobia—the fear of hospitalization.
Story after story, incident after incident, the tales of medical woes came
pouring in. Who can forget the story of Willie King? 52-year-old King
entered a hospital in Tampa, Florida to have his left leg operated on.
Somehow during the process, the surgeons operated on the wrong leg and,
due to a surgical complication, were forced to amputate his right leg. Can
you imagine awakening from anesthesia to discover this egregious error?
Surgical errors, medication errors, and infections are all part of what the
Institute of Medicine has labeled as preventable medical harm.
The question at this point in time is, has safety in our health care system
improved? Unfortunately, it may not be that easy to answer. There are a
few variables that must be considered before we can fully determine if
there has been a decrease in medical errors. These variables are increased
use of hospitals, underreporting, and staffing.
Increased Use of Hospitals
There are simply more people using hospital services today than there were
in 1999. One of the main reasons is that the United States has seen a sharp
increase in the number of individuals receiving elective surgeries. Plastic
surgery, elective reconstructions, weight loss
procedures—all of these fall into what has been termed “boutique health
care.” If you have money to spend, there is a procedure available. Another
reason why hospital use has increased is related to the stagnant economy.
As more individuals lose insurance coverage, the hospital (through the use
of the emergency room) has become the center of primary care for millions
of individuals. The Emergency Medical Treatment and Active Labor Act, or
EMTALA for short, made it illegal for any hospital that receives federal
reimbursement to deny health services to anyone in urgent medical need.
By sheer definition, anyone entering into the emergency room is considered
in urgent medical need and is thereby assured access to medical care. The
costs of EMTALA and other related legislation will be
addressed in a subsequent module. The bottom line is there are simply more
people using hospitals. As such, the numbers of medical-related errors
would be expected to rise.
Underreporting
Imagine if you needed to go to the hospital. One hospital has a great patient
safety record. In fact, it was a runner-up in the Baldrige Quality Award. The
other hospital has a reputation for cutting costs and is constantly in
violation of various standards. It is fairly obvious which one you would
choose. Now, imagine if you were not told about the differences. That
would be very frustrating; however, that is our current reality. Efforts to
standardize reporting have achieved little success. In Module One, we found
it difficult to define quality; imagine the difficulty in trying to agree to what
constitutes an error. Even if we did agree to an error standard, the problem
we are now faced with is the actual reporting of such an occurrence. What
would lead a medical professional to not report a problem? The answer is
simple—fear of retribution. In a recent study of over 600,000 health
professionals, over half stated that they believed that their mistakes would
be held against them. Instead of coming forward to report errors, the
majority of those surveyed believed that not reporting would be the better
option.
Staffing
The last variable to consider before we determine whether safety has
improved is that of staffing. Our health care delivery system is enormous in
size and has grown dramatically since 1999. Unfortunately, the pool of
qualified professionals has not grown in proportion. Facing severe staffing
shortages, some states have passed legislation mandating staff-to- patient
ratios; however, even under intense legal pressures, many providers are
unable to meet standards. Staff that remain are often overworked, and
many report extreme stress and fatigue, a deadly combination when it
comes to medical service delivery. In terms of patient safety, the most
costly reported medical mistake is that of medication error. Tired
staff may not read labels correctly or may inadvertently give the wrong dose
at the wrong time, for instance. Today, there are more than 100,000
compounded drugs available in the United States. It is no wonder that many
of them sound or look alike. Primidone versus Prednisone, Celexa versus
Celebrex. It is currently estimated that medication errors cost $4 billion a
year in related expenditures. In this week’s resources, read the article
“Glaxo Whistle-Blower Lawsuit: Bad Medicine” for a terrifying account of
one pharmaceutical company’s lack of quality oversight.
In essence, then, where is quality and patient safety today? Have we
improved since the IOM’s report issued in 1999? As administrators and
health care professionals, what can we do to improve our safety
performance and diminish costly errors? This week’s readings and resources
are designed to allow you to determine the answer for yourself.
References
Greenfield, S., & Kaplan, S. H. (2004). Creating a culture of quality: The
remarkable transformation of the Department of Veterans Affairs health
care system. Annals of Internal Medicine. 316-W-61.
Wachter, R. M. (2004). The end of the beginning: Patient safety five years
after ‘to err is human.’ Health Affairs, 23534-545.
Doi:10.1377/hlthaffw4.526
