Video Transcript: Error vs Harm

David Bates, MD, MSc, Senior Vice President and Chief Innovation Officer for Brigham and Women’s Hospital

Everyone makes errors all the time. It's sort of a part of the human condition. Even someone who tries their very best will still make some errors. We move from focusing on error to focusing more on harm in part because it's become clear that for many things that we thought were not preventable we can actually prevent a very large proportion.

The classic example is CLABSI, or catheter-related bloodstream infections, where at one time we thought that was just a complication of having a central venous catheter in place, but now we know that if you follow a set of procedures, or bundle, you can essentially eliminate those infections.

We’ve had similar findings for a number of other areas, so I think it makes much more sense to focus primarily on harm.

There are many different definitions of harm. The Harvard Medical Practice study defined harm as harm that resulted in death or disability at discharge or prolonged hospital stay by two or more days.

I think that’s too narrow a definition. I think it should include anything that causes a substantial issue for a patient, so something like an IV infiltration might not have been considered harm by the Harvard Medical Practice study, but I think it should be considered harm and it should be something that we’re striving to prevent.