While noting that progress has been "frustratingly slow" and difficult to measure, Harvard School of Public Health Adjunct Professor Lucian Leape, M.D., and Institute for Healthcare Improvement Chief Executive Officer Donald Berwick, M.D., detailed the achievements, obstacles to further progress and future goals of the patient-safety movement in a "special communication" published in the May 17 issue of the Journal of the American Medical Association.
In the report, the authors lamented that since the Institute of Medicine published To Err Is Human: Building a Safer Health System five years ago, there still is no national monitoring system for patient safety, more federal money is needed for safety research, and healthcare cultures and reimbursement structures often work against safety improvement. The IOM report stated that as many as 98,000 people die annually from medical errors.
On the positive side, Leape and Berwick said the concept that systems -- not individuals -- are mainly responsible for medical errors "has become a mantra in healthcare." They also commended dramatic advances in the implementation of electronic medical records, the use of proven safe practices and full disclosure of injuries to patients.
The authors called on leading healthcare organizations to set "explicit and ambitious goals" for the next five years, such as reducing medication errors by 50%, reducing nosocomial infections by 90% and elimination of events on the National Quality Forum's list of "never events."
"Resistance is already fading as more and more evidence comes on board that creating a nonpunitive environment and changing systems really does work," Leape said in an e-mail interview. "We didn't get to the moon by listening to the people who said it couldn't be done. . . . The naysayers are a side show, increasingly ignored."