Ten Years After "To Err Is Human"

Ten Years After sang "I'd Love to Change the World" more than ten years ago. 

Sadly, ten years after the seminal IOM report on medical errors — To Err Is Human — was released, we should all be singing that song, because that wake-up call has gone largely unheeded; or perhaps a better way of putting it would be to say that efforts to address the issues raised by the report have not been uniformly successful.  The Interdisciplinary Nursing Quality Research Initiative released the following observations today:

In 1999, the Institute of Medicine’s (IOM) groundbreaking “To Err Is Human” report found that as many as 98,000 people die each year from medical errors in hospitals, making medical errors a more common cause of death than motor vehicle accidents, breast cancer, or AIDS. The report estimated that these errors cost the country nearly $38 billion each year.

Ten years later, medical errors are still a widespread problem in the American health system.  More than 1.5 million Americans are sickened, injured, or killed by medication errors each year.  1.7 million Americans battle illnesses due to hospital acquired infections, 99,000 of whom die.

INQRI posted several perspectives on the topic on its blog, including an interview with BIDMC CEO and blogger Paul Levy.  Like many health care organizations across the country, BIDMC has worked to improve quality and address medical errors over the years and, in fact, was recently recognized by the Leapfrog Group as one of 45 "Leapfrog Top Hospitals" nationwide.

The information from INQRI shows that medical error morbidity and mortality is on the rise, not on the decline, despite the attention paid to this vexing issue in the decade since "To Err Is Human." 

The question remains: How can these quality issues be addressed in the context of current health reform efforts?  Where are the "best practices" that all health care providers can learn from?  Are there best practices that are easily transferable from setting to setting?  Much has been said about "bending the cost curve," but more needs to be said — and, more importantly, done — about taking concrete steps to improve quality by aligning incentives properly.  Payment system reform, creating new incentives for efficient and effective care delivery, ought to be closer than it is to front and center in the current health care debate.  In addition, more attention must be paid to aligning the incentives of the various payers in the health care delivery system.  For example, employment of physicians seems to be the way of the future, though some folks trying to move large systems in that direction have been burned (Exhibit A: Alegent).  Integrated delivery systems with employed physicians seem to be able to do the best at aligning incentives, though there are certainly some counterexamples out there (including BIDMC).

This is an issue that must be addressed by lawmakers, payors and the delivery system, working together — or at least aiming in the same direction.  Thus far, we have seen only incremental progress, at best.  

David Harlow
The Harlow Group LLC
Health Care Law and Consulting