Modern Healthcare: At what point did you realize that you had 'fathered' a 'child' that could change the healthcare industry? Lucian Leape
Lucian Leape: I didn't know whether it was going to be a movement or a (medical) specialty, but it was apparent to me very quickly that this was going to be something big. Around 1990, I realized that there was almost nothing in the medical literature, but there was a treasure-trove of information.
I didn't know how it was going to play out. When I became acquainted to the literature outside of medicine -- such as human factors engineering -- I realized we were on to something.
MH: At what point did you realize you had become the 'father' of that 'child?' Leape
Leape: At the first Annenberg conference in the fall of '96, two years after I published Error in Medicine. Half the people there were not in healthcare and everybody sort of treated me like the guru of patient safety, and I hadn't ever been treated like that before.
That meeting, it was one of discovery and getting the feeling that you weren't alone. You had a relatively small number of people interested in the subject, and it was a discovery of being among kindred spirits.
Then, over the next five years, the focus was on how bad it is or on arguments over whether it was 5,000 deaths (caused by medical errors) or more than 200,000. Now, we're all beyond that and the focus of the (recent National Patient Safety Foundation) meeting was results -- what works and how we can learn from what other people are doing.
MH: Did your 'child' grow up the way you expected? Leape
Leape: When we first got started, I didn't have a clear idea how it would turn out. I knew people wouldn't be happy about the numbers, and I assumed some physicians would have trouble with that. But I thought more physicians would be interested in improving patient safety. I'd say I was disappointed by the lack of enthusiasm from doctors in trying to improve.
I was disappointed that there was more reluctance than I expected and not more support at the national level from the president and Congress. AHRQ (the U.S. Agency for Healthcare Research and Quality) has done some great things, but it hasn't gotten much financial support.
MH: What factors had a positive or negative influence on how your 'child' grew up? Leape
Leape: We've attracted outstanding leaders to patient safety. Don Berwick and his outfit, IHI (the Institute for Healthcare Improvement) have had a great influence on training people. Ken Kizer, he's done two great jobs: first, with the Veterans Administration and teaching people about patient safety and then, starting with nothing, really, and getting the National Quality Forum established and developing its list of 'never events' and lists of safe practices. (The late) John Eisenberg really had a powerful effect with AHRQ and getting that agency focused on patient safety. Dennis O'Leary has had an impact, making JCAHO (the Joint Commission on Accreditation of Healthcare Organizations) move toward patient safety. ...
The IOM report, To Err Is Human -- nothing the IOM has ever done has had the impact of that report. So, it's not 'When did patient safety start?' but 'When did a movement start with national and international awareness?' It was with the IOM report. None of us anticipated that. ...
On the downside, the reluctance of physicians has bothered me the most. They are still afraid of malpractice suits and won't talk about their mistakes, and aren't convinced yet that the whole systems idea we talk about is what it is. A lot of hospitals still haven't made safety their main priority, and that's unfortunate.
Most of us didn't foresee rise of the patient-advocate movement. They certainly brought front and center the whole issue of communication, full disclosure and apologizing for errors -- which we should have been doing all along. The IOM report got people's attention, and then major healthcare leaders picked up the challenge, then there were major research findings, and now there's been interest by purchasers with the Leapfrog Group, and payers are interested in doing the right things, too.
MH: What do you see as your 'child's' future? Leape
Leape: First, it's here to stay. I think the culture is beginning to change. Everyone realizes this is important, and we have a lot of work to do. People are no longer asking if they should do something. Now, it's 'What's the most important and effective way to move ahead?'
With developments like the IHI's 100K Lives campaign and Peter Provonost's work in Michigan, where 68 (intensive-care units) have gone six months or longer without a single bloodstream infection or case of ventilator-associated pneumonia, I wouldn't say we're at a tipping point yet, but we're certainly developing momentum.
We're at the time when we can start delivering some very tangible results. The better we get, the better we'll get, and we've started the acceleration phase: getting away from talking about how bad it is to doing something about it. And it's not just technology and gizmos. Team training and communication are important aspects. At its roots are relationships and how we work together. We have a long way to go toward improving how we work together, but it's now an agenda item, and I think we'll see a lot of progress in the next few years.
We have to get liability carriers to do the right thing. They have to be a lot more progressive about errors that cause injuries. When we hurt someone with a mistake, we should pay them right away and not make them have to take us to court and sue us.
One of the major changes I see is that hospitals are focusing on and talking about injuries rather than errors. We make a lot of errors that don't do anything. Focusing on adverse events makes more sense.
What's impressive is to come back to the success, like eliminating central-line infections or post-operative infections. It changes the whole direction of the discourse. There's less 'Isn't it awful?' and more 'How do we change things?' and 'Let's see what we can learn.'
That's a healthier way to look at it.