Written by: Dr. Kathy Gennuso

Though it has been many years since the 1999 Institute of Medicine’s (IOM) report, consensus in the medical community suggests that little has been done to improve upon medical error statistics since. Even though more attention has been paid to patient safety initiatives through congressional hearings, media attentions, and anxious patients, most believe it has been insufficient. This leads one to ask – why.

Traditionally, the perception of medical errors held by the public, professionals, and regulators was one of individual culpability. This is a mindset reinforced by medical and nursing curricula, a tort-dominated system for accountability, and, human intuition. Blaming a person when things go wrong is a natural human tendency. It became difficult to blame an individual as healthcare facilities transitioned from a doctor’s office and small rural hospital to group facilities and hospital conglomerates. As the healthcare environment was shifting to more of a business model, patient safety was not always the top priority. It became easier to ignore individual accountability when negligence could be transferred to the organization. Driven by both corporate negligence reprimands and individual moral conflict of both the clinicians and healthcare executives, patient safety initiatives are beginning to be embraced. But are we fixing the symptom and not the problem?

Before 1999, most in the medical profession, and many even today, believe that medical errors were unavoidable collateral damage of a heroic, high-tech war they otherwise seemed to be winning. This attitude was developed and enforced in the medical curricula. In fact, the high personal standards of doctors and nurses may make them particularly vulnerable to the consequences of errors. The culture of medical school and residency implies that mistakes are unacceptable, and, when serious, point to a failure of effort or character. Moreover, despite the fact that patient outcomes are increasingly determined by how well teams function under pressure, no teamwork training is yet required of providers, and few medical and nursing schools include it in their curricula. Even when institutions have invested in such training, it is usually offered in small organizational units. Unfortunately, there is a huge gap between the promise of teamwork and actually achieving harmony.  

Often the healthcare culture supports an environment of isolation with few open discussions of errors. Part of establishing a culture of patient safety is developing a framework for consistent accountability – reconstructing the environment, where accountability is poorly defined and where employees are unclear what their roles or the rules are. Yet many experts believe that reporting by physicians cannot be achieved without drastically limiting or eliminating legal liability.

What do you believe?