hospital negligence rates no lower after decade of effort part ii

Research recently published in the New England Journal of Medicine (NEJM) revealed that, despite ten years of effort, there has been no systemic reduction in patient injuries and deaths caused by hospital negligence.

In the year 2000, a national study by the U.S. Institute of Medicine found that medical malpractice at hospitals resulted in an average of a million patient injuries and 98,000 deaths every year. Hospitals, governments and patient safety advocates have invested considerable resources to improve those rates over the past decade, but the results have not been uniformly effective.

According to the study’s authors, the problem is not that patient safety protocols and initiatives don’t work. The problem is a failure among hospitals and health care professionals to implement those initiatives systemically.

In the first part of this series, we discussed the specific findings of the NEJM report, which found that more than 25 percent of the patients studied had experienced a medical error — two-thirds of which were entirely preventable.

In this part of the series, we will discuss the cultural change the study’s authors say is needed to systemically improve patient safety in hospitals.

Patient Safety Protocols Proven to Work, But Nationwide Implementation Spotty

The NEJM report found a wide spectrum of preventable harm to patients, including diagnostic errors, prescription errors, nursing errors, negligent treatment of diabetes, hospital-acquired infections, surgical malpractice and even patient falls caused by hospital negligence.

Dr. Lucian Leape, a Harvard health policy analyst and co-author of the 2000 Institute of Medicine report, says what is needed is a cultural shift.

“In order to change the way we do things, we have to work effectively as teams, and to become a good team is difficult in healthcare because that’s not how it’s set up; that’s not how we train our doctors,” said Leape, who served as an advisor on the NEJM study.

“Methods to change patient safety are going to be implemented differently at different hospitals because each place is has its own system,” said the Institute of Medicine’s Samantha Chao, a patient care research specialist who was not involved with the study.

Lead author Dr. Christopher Landrigan, a physician at Boston’s Brigham and Women’s Hospital, points out that individual hospitals have achieved significant reductions in negligent harm to patients. For example, some Michigan hospitals reduced the rate of hospital-acquired infections to nearly zero in three years by implementing a patient safety checklist developed at Johns Hopkins.

The NEJM report pointed to several patient safety interventions known to be effective: computerizing medical records and prescription orders, limiting residents to working no more than 16 consecutive hours, and implementing evidence-based care protocols such as checklists for surgical procedures.

Leape argues that patients also need to become more actively involved in ensuring their own safety. He suggests asking doctors and nurses to wash hands, making sure they’re receiving the right medication, and inquiring about possible drug interactions.

“Some patients are uncomfortable doing that,” he said, “but asking a doctor to double-check something isn’t insulting them; it’s just recognizing that mistakes can be made.”


  • Reuters Health, “Harm in hospitals still common for patients,” November 24, 2010
  • New England Journal of Medicine, “Temporal Trends in Rates of Patient Harm Resulting from Medical Care,” Christopher P. Landrigan, M.D., M.P.H., Gareth J. Parry, Ph.D., et al, November 24, 2010

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