A recent article in the BMJ asserts that if the US government included medical errors in its calculations, such errors would rank as the third leading cause of death in the country.
It’s no surprise that such a bold statement has produced controversy. The main point of contention, it seems, is the estimate of 250,000 deaths. This is different from the Institute of Medicine’s estimate of 98,000 in To Err Is Human and The Journal of Patient Safety’s estimate of 400,000. And while we may debate whether the number is 98,000, 250,000, or 400,000, we can all agree that it’s too many.
But another assertion in the BMJ article deserves more attention: While it’s necessary to focus on unnecessary deaths, it’s not sufficient. There are many more instances of harm caused by medical error than deaths. People are suffering a whole range of adverse events — due to health care-acquired infections, medication errors, incorrect diagnoses, and much more — and we ought to put our energies into preventing those as well.
In fact, I would go still further. I think we have been overly cautious in our assessment and definition of harm.
When we calculate preventable harm, we don’t generally count people harmed because of health inequity. We don’t count people harmed because of the overuse of medical care. We don’t count those harmed by lack of access to medical care. We also rarely include the patient or family perspective on what constitutes harm and its real and lasting consequences.
How we define harm is relatively narrow. We need a debate about what is harm.
For example, Lauge Sokol-Hessner, MD; Patricia Folcarelli, RN, PhD; and Kenneth E. Sands, MD, MPH and their colleagues at Beth Israel Deaconess Medical Center in Boston include harm resulting from disrespect in their efforts to eliminate preventable harm to patients. We must learn from and expand upon their work.
The debate over how we calculate the extent of unnecessary harm is productive. I support any discussion that helps us more deeply understand patient safety.
But if we wait until all the analysis is complete before we act, we’ll do our patients a disservice. Let’s accept that there is some disagreement about what we count and how we count it. While we’re having that debate, let’s not lose sight of the need to prevent deaths due to medical errors in our hospitals.
I believe that the BMJ article has done us a great service. It has cast a light on patient safety as an enduring issue and raised patient safety in the public consciousness.
And I plan to keep that light shining by talking more about expanding our definitions and understanding of harm in my keynote at IHI’s National Forum in December. In the meantime, I look forward to your feedback in the user comments below or on Twitter.
Editor’s note: Look for more from IHI President and CEO Derek Feeley (@derekfeeleyIHI) on leadership, innovation, and improvement in health care in the “Line of Sight” series.
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