Making Our Health Care Systems More Resilient

Managing an illness or injury and the medical system is not an easy task.

Posted Jan 11, 2011

Adversity often comes in the form of a medical crisis for ourselves or for someone we care about. Managing an illness or injury, and the medical system that we must depend on, is not an easy task. It is obvious that we, or our loved one, must be resilient to survive, but perhaps less obvious that the medical system that we depend upon must be resilient so that the attempted cure does not kill the patient.

As reported in The New York Times (November 25th, 2010), a study of patient safety was conducted from 2002 until 2007 in ten North Carolina hospitals. The study found that 18% of patients were harmed by medical care, some more than once, and that 63% of the injuries were judged to be preventable. The good news was that most of the problems were temporary and treatable, but some were serious, and a few fatal. The author of the study, Dr. Christopher P. Landrigan, pointed out that process changes may help somewhat. However, the key for improving these statistics is through educating providers on how to identify and fix safety hazards, and by encouraging a culture of strong communication and teamwork. What Landrigan is describing here is a resilient medical system.

Other studies like those from the Institute of Medicine suggest that a correct diagnosis is either missed or delayed in 5% to 14% of urgent hospital admissions and diagnostic error rates overall are between 10% and 20%. These statistics come from research by Ian Scott, the Director of Internal Medicine and Clinical Epidemiology at Princess Alexandra Hospital in Brisbane, Australia. Scott and other researchers have found that errors in physician reasoning may account for many of these mistakes. The problem Scott points out is not just incompetence or inadequate knowledge, but it is when physicians get stuck in a particular mode of thinking. An accurate diagnosis may require flexible thinking, e.g., being able to think outside of the box.

Resilient medical systems have ways of catching physician mistakes and errors. This often involves the use of rules and crosschecks. For example, many hospitals have what is called an "ad hoc rule" that chemotherapy should not be started on weekends because the most knowledgeable physicians and pharmacists usually do not work on weekends. Unfortunately, that rule may be overlooked when someone has a rapidly growing cancer or wants to start treatment immediately. So...what to do? More about this in the next post.

Psychologist Ron L. Breazeale, Ph.D., is the author of Duct Tape Isn't Enough.