A National Conversation About Patient Safety and Medical Errors

As 2017 comes to an end, it seems only natural to reflect on the tumult the year has brought to health care. Amid sometimes bitter debates about the best ways to provide health insurance and improve the healthcare system, Americans have heard a lot from politicians this year, while sometimes struggling to have their own voices heard.

Seeking input from individuals and communities, however, is a critical component for making improvements in every aspect of health care. Their voices are central to ensuring care is safe, effective, and reliable. ^a

Earlier this year, two national, not-for-profit organizations—the National Patient Safety Foundation (NPSF) and the Institute for Healthcare Improvement (IHI)—merged with the recognition that, by combining their strengths in advancing patient safety and healthcare quality, they could have a greater impact on improving health care in the United States and worldwide.

To take a measure of the public’s perspectives, the IHI/NPSF Lucian Leape Institute, a program of the merged organization, in partnership with the independent research institution NORC at the University of Chicago, recently conducted a public opinion survey of 2,500 U.S. adults representing a cross-section of the population. ^b

The survey results yielded some good news and disclosed areas of agreement—notably, that the vast majority of Americans are using the healthcare system and largely have positive interactions when they do. Nine in 10 respondents report having visited a healthcare provider in the past year. Most say that, when they sought care, it was provided in a calm and organized setting, that the treatment was explained to them and carried out as described, and that they were well informed about after-care and whom to contact if they had questions or concerns following treatment.

The Need for Improved Patient Safety

When asked about patient safety, however, 21 percent of survey respondents said they had experienced a medical error in their own care, and another 31 percent said they had been closely involved in the care of a patient who had experienced an error. Combined, 41 percent of adults in the United States have some experience with medical error, either directly or indirectly.

What lessons does this information offer to our leaders in Washington? It should serve as a reminder that patient safety must be part of the national conversation at the policy level.

To date, most patient safety improvement efforts have been conducted in hospitals. The Agency for Healthcare Research and Quality (AHRQ) has reported on progress resulting from these initiatives, including decreases in hospital-acquired conditions such as infections, falls, and pressure ulcers. ^c

Clearly, improving patient safety in hospitals is important and necessary. Yet most care is provided in outpatient settings, including the patient’s own home. This fact is borne out by the fact that most of the survey respondents who experienced an error said it occurred outside of a hospital, in settings such as physician offices, clinics, emergency departments, ambulatory surgical centers, and nursing or rehabilitation facilities. The survey results support greater attention to safety across the continuum of care.

Focus on Preventable Harm—Including Emotional and Financial Harm

We also need to focus more specifically on the consequences of preventable harm in health care. Survey respondents who experienced a medical error were more likely than those who had no such experience to say they had been harmed during a healthcare encounter. Most who were harmed said the experience had a long-term or permanent impact on their physical or emotional health, their financial well-being, or their family relationships. When preventable harm occurs from medical care, immediate attention to any physical ramifications is the obvious priority. But we also must pay more attention to the increasing research on emotional harm that people experience in our healthcare system, and remember that family dynamics and finances also can suffer because of a medical error.

Reporting of Errors

Nearly half of survey respondents who experienced an error said they reported it to someone on their care team or a staff member at the facility where they were treated. This is good news and an indication that patients are feeling comfortable, and more empowered, to speak up when they think something is not right. Of those who did not speak up, however, more than half did not think it would do any good, and 40 percent did not know how to report the error. This finding points to a significant opportunity to better educate the public about the importance of reporting errors and what mechanisms are available for them to do so.

Responsibility for Patient Safety

Not surprisingly, when asked which people or entities are most responsible for patient safety, 94 percent of survey respondents said physicians, nurses, and other healthcare providers, while 89 percent said hospital leaders and administrators. Notably, 85 percent said patients, family members, and caregivers share that responsibility. A smaller number (66 percent) said government had a role in ensuring patient safety, yet there is much more the government can do to promote and improve support for patient engagement and patient-centered care.

The Need for a Public Health Approach

Health care is a unique industry in that it will touch every one of us at multiple points in our lives, in various and disparate ways. That fact was never adequately acknowledged during this year’s political debates about health care, even as patients continue to need and seek out care and dedicated clinicians endeavor to provide it. Much of what IHI/NPSF learned through this survey about the public’s experience and understanding of medical errors underscores the need to address patient safety through a public health approach. ^d And efforts to inform, educate, and empower people and communities are essential elements of such an effort.

Tejal K. Gandhi, MD, MPH, CPPS, is chief clinical and safety officer at the Institute for Healthcare Improvement, Cambridge, Mass., and formerly president and CEO of the National Patient Safety Foundation, Boston.

Footnotes

a. Frankel, A, Haraden, C., Federico, F., and Lenoci-Edwards, J.,  A Framework for Safe, Reliable, and Effective Care , White Paper, Institute for Healthcare Improvement and Safe & Reliable Healthcare, 2017

b. NORC at the University of Chicago and IHI/NPSF Lucian Leape Institute, Americans’ Experiences with Medical Errors and Views on Patient Safety , Cambridge, MA: Institute for Healthcare Improvement and NORC at the University of Chicago; 2017.

c. AHRQ, Efforts to Improve Patient Safety Result in 1.3 Million Fewer Patient Harms , page last reviewed November 2015.

d. National Patient Safety Foundation, Call to Action: Preventable Health Care Harm Is a Public Health Crisis and Patient Safety Requires a Coordinated Public Health Response , 2017.