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How Safe Is Our Health Care System?
How Safe is Our System?
Molly Coye, M.D., M.P.H., Senior Vice President, The Lewin Group, Member, Institute of Medicine (IoM) Committee on Quality of Health Care in America, San Francisco, CA.
Findings from the 3-year study by the IoM Committee on Quality of Health Care in
America were based on reviews of scientific research and studies, interviews with experts, and
an analysis of trends. The committee was surprised by the strength of their finding that medical
errors were perhaps the biggest challenge facing the U.S. healthcare system. Findings show
similar trends to studies conducted 10 years ago. Although there may be disagreement on the exact
number of medical errors that occur, no one objects to the magnitude of the problem as
reported by the IoM.
The IoM Report identifies improved reporting as critical to reducing medical errors. Providers, healthcare administrators, and policymakers cannot resolve what they do not know. Barriers to reporting are obvious: confusion about what must be reported, concern about confidentiality of data, liability, and public disclosure of information. Much attention has been directed at whether reporting should be voluntary or mandatory, each with its own implications for implementation.
There is some disagreement about whether both mandatory and voluntary reporting is needed as
recommended by the IoM. The need for public accountability drove the IoM to recommend mandatory reporting. But whether mandatory or voluntary, the harder question for either system is what to do with the data once they are reported.
States play important roles in both protecting public safety and improving healthcare systems. The IoM advocates mandatory reporting to States of adverse events, initially by hospitals and eventually by other institutional and ambulatory care delivery settings, some of which will
require State enforcement action when the event results in serious harm. States can also play important roles in analyzing and disseminating findings from voluntary reporting systems, although the resources and specialized skills to do so are more demanding. Pooling resources across States may be one approach to effect broad-based change.
Physicians express concerns that defining medical errors is not easy because medicine does
not always lend itself to standardization. The intent of reporting is to attempt to make improvements by better understanding the mishaps of others. The assumption is that reporting should be only the first step. Systems to evaluate and improve processes of care also need to be established. These systems should provide ongoing feedback within an organization so that errors and problems can be detected and corrected as early in the process of care as possible.
Kohn LT, Corrigan JM, Donaldson MS, editors. To Err is Human: Building a Safer Health Care System. Washington (DC): Institute of Medicine, 2000.