Patient safety and human error: the big picture

For most of the past century, health care literature including many books written about health care and its quality have documented the problems of errors in health care delivery. That outcomes of care have differed significantly among hospitals has also inferred that perhaps the "best practices" or the appropriate resources may not have been used, although most of these study results have be adjusted for case mix. The Institute of Medicine's recent publication, "To Err is Human," represents their review of studies quantifying medical errors in health care and their recommendations for eliminating such errors to the extent possible. One should note that, while using the term "medical," it does not infer that all errors are made by physicians. It recommends shifting the focus of study from blaming the health providers to studying the "system" in which health care is provided, believing that most of the errors committed are not reckless but rather result from system variables. The Institute of Medicine's recommendations are broad and cover a variety of quality assurance mechanisms. It recommends mandatory reporting of these errors to a central agency via a state mechanism, with better and broader legislation to make peer review, for purposes of studying errors with a view toward making change in the system, privileged information, and not subject to subpoena. The American Medical Association and American Nurses Association, in their testimony before the US Senate Committee on Appropriations, Subcommittee on Labor, Health and Human Services, Education and Related Agencies, on December 13, 1999, support the recommendations in general with a few reservations.