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Faced with these stunning statistics, the Institute of Medicine has initiated a project to examine the issues and recommend rigorous changes in American health care. First in the series of publications from the Quality of Health Care in America project, To Err Is Human breaks the silence that has surrounded medical errors and their consequences -- but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agenda -- with state and local implications -- for reducing medical errors and improving patient safety through the design of a safer health system.
This volume reveals the often startling truth of medical error and the disparity between the incidence of error and public perception of it. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided and then looks at the handling of medical mistakes.
Using a detailed case study, the book reviews the current understanding of why these mistakes happen. Recognizing that legitimate liability concerns may discourage reporting of errors, the book asks, "How can we learn from our mistakes?"
Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care.
To Err Is Human asserts that the problem is not bad people in health care -- it is that good people are working in systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care they receive.
This book will be vitally important to federal, state, and local health policymakers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health care-givers, health journalists, patient advocates -- as well as patients themselves.
|1||A Comprehensive Approach to Improving Patient Safety||17|
|Patient Safety: A Critical Component of Quality||18|
|Organization of the Report||21|
|2||Errors in Health Care: A Leading Cause of Death and Injury||26|
|How Frequently Do Errors Occur?||29|
|Factors That Contribute to Errors||35|
|The Cost of Errors||40|
|Public Perceptions of Safety||42|
|3||Why Do Errors Happen?||49|
|Why Do Accidents Happen?||51|
|Are Some Types of Systems More Prone to Accidents?||58|
|Research on Human Factors||63|
|4||Building Leadership and Knowledge for Patient Safety||69|
|Why a Center for Patient Safety Is Needed||70|
|How Other Industries Have Become Safer||71|
|Options for Establishing a Center for Patient Safety||75|
|Functions of the Center for Patient Safety||78|
|Resources Required for a Center for Patient Safety||82|
|5||Error Reporting Systems||86|
|Review of Existing Reporting Systems in Health Care||90|
|Discussion of Committee Recommendations||101|
|6||Protecting Voluntary Reporting Systems From Legal Discovery||109|
|The Basic Law of Evidence and Discoverability of Error-Related Information||113|
|Legal Protections Against Discovery of Information About Errors||117|
|Statutory Protections Specific to Particular Reporting Systems||121|
|Practical Protections Against the Discovery of Data on Errors||124|
|7||Setting Performance Standards and Expectations for Patient Safety||132|
|Current Approaches for Setting Standards in Health Care||136|
|Performance Standards and Expectations for Health Care Organizations||137|
|Standards for Health Professionals||141|
|Standards for Drugs and Devices||148|
|8||Creating Safety Systems in Health Care Organizations||155|
|Key Safety Design Concepts||162|
|Principles for the Design of Safety Systems in Health Care Organizations||165|
|A||Background and Methodology||205|
|B||Glossary and Acronyms||210|
|D||Characteristics of State Adverse Event Reporting Systems||254|
|E||Safety Activities in Health Care Organizations||266|