Health Affairs, 22, no. 2 (2003): 102 doi: 10.1377/hlthaff.22.2.102 © 2003 by Project HOPE	New Online   How Would Obama, McCain Cover The Uninsured?   Cost To Cover Uninsured   Let Health IT Market Evolve   How Rate Health IT Progress?   HIV/AIDS In India, China

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Patient Safety

PROLOGUE

Failure To Ensure Patient Safety

The scope of the problem appears to be staggering. The seminal 1999 Institute of Medicine (IOM) report, To Err Is Human: Building a Safer Health System, found that as many as 44,000–98,000 people die in hospitals each year because of medical errors, making errors the eighth leading cause of death in the United States—ahead of motor vehicle accidents, breast cancer, and AIDS. Despite such dramatic findings and the emphasis placed on the need for systemic reform rather than placing blame on individuals, proposed remedial policy interventions have appeared to inspire little more than a tepid response from physicians. This lack of urgency has been particularly frustrating to proponents of quality improvement, given evidence that improvements at the system level can, in fact, work to reduce medical errors.

The papers that follow explore the roots of the medical community’s seeming reluctance to acknowledge the severity of the medical error problem, the resultant price paid by the profession in terms of eroded public trust, and interventions intended to both heighten visibility of such issues and ensure corrective action. First, Michael Millenson attempts to deconstruct the historical refusal of the medical community to confront the role played by practitioners and hospitals in the medical error crisis. He asserts that such resistance not only has served to hamper efforts to formulate corrective policy interventions but also threatens to erode the very ethical underpinnings of the profession itself. Millenson, accordingly, challenges the IOM to abandon "gradualism" in favor of taking a more activist role in bringing about positive change. Perspectives by Carolyn Clancy and by William Richardson and Janet Corrigan follow.

Next, Arnold Milstein and Nancy Adler use signal detection theory as a framework for discussing specific cognitive and motivational factors that often inhibit stakeholders’ awareness of clinical errors. The authors applaud the efforts of the National Quality Forum "to create universally visible, provider-specific measures of quality" and of the Leapfrog Group to "publicly identify and reward provider breakthroughs in patient safety," and they challenge health industry leaders to maintain focus on the issue of reducing medical errors.

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