December 18th, 2009

Writes Pauline Chen, M.D. for the New York Times:

Ten years ago, a national panel of health care experts released a landmark report on medical errors in the American health care system. Published by the Institute of Medicine, “To Err is Human: Building a Safer Health System” estimated that as many as 98,000 people died in hospitals each year as a result of preventable mistakes. Being hospitalized, it turned out, was far riskier than riding a jumbo jet.

While the report offered comprehensive strategies to improve safety, its main conclusion was that medical errors were primarily a result of “faulty systems, processes and conditions that lead people to make mistakes or fail to prevent them.”

Spurred on by this finding, health care leaders across the country began addressing errors believed to be a result of systemic flaws. They instituted more rigorous hospital accreditation standards and procedures, increased public reporting and transparency and established systemwide safety changes like the mandatory use of checklists, the placement of hand sanitizing gel dispensers throughout hospital wards and the regulation of physician duty hours. For nearly a decade, this paradigm of systems failure defined the national movement to improve patient safety.

But more recently, some health care safety experts have begun questioning the assumption underlying the report’s conclusions: that only health care systems, and not individual clinicians, could be held accountable for medical mistakes.

Dr. Robert M. Wachter, a professor of medicine at the University of California, San Francisco, and a national leader in patient safety, recently published two critiques of the safety movement, one in Health Affairs and one in The New England Journal of Medicine. Both urge physicians to begin acknowledging their individual roles in medical errors.

Read much more, including a Q&A with Dr. Wachter, at the NYT.