QUALITY: Millenson demands a shock to the system

Writing an Op-Ed in USA Today, Michael Millenson says that making a national error reporting system voluntary won’t work. The Senate voted 98-0 to create such a system last week and USA Today had an editorial saying that it was a good idea, but should have gone further. In some ways that such articles appear in the mainstream press shows the great progress since the IOM issued the To Err is Human report, given organized medicine’s ability over the previous century to quiet the incipient debate on the medical error and quality topic, (as detailed by Millenson in the wonderful Demanding Medical Excellence). But the IOM set out a goal of a reduction in errors of 50% in five years. Well the report was issued 5 years ago next month and no one is pretending that target has been reached (outside of LDS hospital in Salt Lake City, scroll down here to the June 10 entry for more on that)Here’s what Millenson said yesterday:

While voluntarism is valuable, it has been five years since a landmark IOM report made patient safety a public scandal. During that time, doctors and hospitals have not voluntarily organized to stop the preventable deaths and injuries of hundreds of thousands of patients with anything close to the energy used to battle malpractice awards worth hundreds of thousands of dollars.

Doctors and hospital managers are not venal and uncaring. In fact, many care so much that they find it too painful to face up to the commonplace nature of errors. As a result, doctors routinely protest that the patient-safety issue is overblown. I’ve seen it firsthand hundreds of times. If you really believe in systemic change, you have to be willing to shock a lethargic system into abandoning the status quo.

The way to do that is with the mandatory reporting of serious errors. In Minnesota, for example, progressive hospitals supported the mandatory reporting and analysis of 27 serious events, along with appropriate confidentiality and legal ”safe harbor” provisions. Moreover, errors are tabulated and made public each year. Across the U.S., a few courageous hospitals even involve patient representatives in error-prevention panels.

No member of Congress would think of making airline-crash prevention voluntary. Protecting the sick and the vulnerable among us is surely at least as important.

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