A Modern “Epidemic”
Some evidence indicates that medical errors are now the third leading cause of death in the United States. This is based on the fact that every hour nearly forty patients die in U.S. hospitals as a result of unnecessary healthcare-induced harm, adding up to about a half a million unwarranted deaths on an annual basis.
These are not deaths due to the lack of access to care or to breakdowns in complex medical decision-making; in general, patient safety events—or medical errors—refer to wrongful events of healthcare death or harm. Most often, patient safety events stem from honest human errors.
The public has a growing awareness of this problem. The level of fear that patients experience when faced with a hospitalization are beginning to return to that of days long ago when the hospital was where patients went to die. And yet, modern medicine can now save lives like never before.
To Fear or Not to Fear Hospitalization
Upon reviewing a manuscript about patient safety that I wrote, Dr. David Antonuccio, Professor Emeritus, University of Nevada School of Medicine, commented:
As a researcher on medication side effects, I have always been somewhat phobic of going into a hospital for care. Gretchen LeFever Watson’s [writing] convinces me my fears are not misplaced!
But, I’m just one of many people whose research and writing might instill fear.
A little over 15 years ago, the healthcare industry publicly acknowledged the reality of the patient safety crisis in American hospitals. Since then, a countless number of clinicians, policy makers, researchers, and others have exerted Herculean efforts to make hospitals safer. Along the way, they have produced educational pamphlets that are distributed to patients during or just prior to being hospitalized. But all these patient safety advisories don’t appear to have made much of a difference. Why?
The Road to Harm is Paved with Good Intentions
According to Vikki Enwistle, a former fellow at Harvard School of Public Health, existing advisories—even those created by leading US healthcare organizations—generate unrealistic expectations. Among other problems, they may create unreasonable demands on lay caregivers given people’s schedules, preferences, and capabilities. Worse yet, some might precipitate a loss of confidence and trust in hospital care. Consider, for example, information that has been extracted from a prominent patient safety advisory.
If you’re going into the hospital…your most important step is selecting someone you trust to be your healthcare advocate…The most important attribute for your healthcare advocate is the willingness and ability to speak up—to ask questions when things happen that you don’t understand and to insist that people take the necessary measures to protect you from harm.
Isn’t it easy to imagine how anxious a patient and/or family members might feel upon reading such information while in the hospital or just before being admitted?
Raising public awareness about safety is important, but current approaches have done little to help people protect themselves or their loved ones. Since the birth of the patient safety movement that began in 2000, there has has not been a discernable downshift in the magnitude of unnecessary patient harm.
What’s more, the Harvard analysis also suggests that existing advisories may do more harm than good by exacerbating a lingering sense of guilt among patients and family members. When mishaps do occur, patients might be left feeling like they should have done more especially if they didn’t speak up or believe they should have persisted longer when providers rebuffed their concerns. The advisories could also cause providers to view outspoken patients as “difficult patients” and allow this perception to influence the quality of their care. Here's how one review summarized the problem.
Most of the literature on patient and family engagement roles focuses on what patients could do (or what researchers and policymakers want patients to do) instead of discussing what behaviors patients and family members currently engage or would be willing to engage during clinical encounters.
What’s a Patient to Do?
Undoubtedly, patients can play a critical role in decreasing the occurrence of patient safety events. However, the utmost care must be taken to prevent the perception that the healthcare industry wishes to transfer the burden of responsibility for safety to patients. Yes, hospitals and other healthcare organizations have an obligation to invite patients to engage in the process—for everyone’s wellbeing—but healthcare organizations cannot demand that all patients become effective partners in safe care, nor can they blame patients when they fail to come to the aid of their providers.
Here’s my question to you: How can we meaningfully engage patients in safety initiatives without inappropriately shifting the burden of responsibility on to them, without disrupting the patient-provider relationship, and without otherwise causing more harm than good?
I hope my forthcoming book will answer this question. Meanwhile, I’d like to hear your ideas. You can respond here or through my website: drgretchenwatson.com.
Mauer, M., Dardess, P, Carman, K.L., Frazier, K., & Smeeding, L. "Guide to Parent and Family Engagement: Environmental Scan Report." In AHRQ Publication No. 12-0042-EF. Rockville, MD: Agency for Healthcare Research and Quality, 2012.
Watson, G.L. "The Hospital Safety Crisis: Unifying Efforts of Healthcare Systems, Public Health, and Society." Society, 53(4), 1-7, 2016.