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Research on ‘Medical Errors’ Published in Journal of Patient Safety

NOTE:  Our peer-reviewed article concerning the prevalence of medical errors experienced by Iowans has been published in the September 2020 issue of the international publication, Journal of Patient Safety (JPS).  The article summarizes the experiences and opinions of a statistically representative sample of 1,010 Iowans, and provides new insights on approaches Iowa can take to determine the extent of the problem and develop solutions to obtain safer care for patients. 

The article, “Medical Errors in Iowa: Prevalence and Patients’ Perspectives,” was co-authored by myself and two others: David R. Andresen, PhD and Andrew Williams, MA. The article reports that medical errors, also known as preventable adverse events, are seldom voluntarily reported by healthcare providers in Iowa and the U.S.

Quantifying the magnitude of the medical error problem is an essential first-step toward solving these safety issues. The hope is that vulnerabilities in the healthcare delivery process will be exposed so that solutions can be found. However, the U.S. does not have a bona fide national strategy to assess medical errors, and, as a result, hospitals and clinicians around the country do not report medical errors accurately and consistently.

The JPS article suggests there is no single method for healthcare providers to promote full, transparent reporting of medical errors. However, the approaches described can serve as a counter-balance to lax provider reporting that includes the patient experience and perspective:

  • Implement mandatory provider reporting and appropriate compliance enforcement. From this, reported errors can help medical organizations more clearly understand exactly what happened, regardless of the outcome of the error, and identify the combination of factors that caused the error or near-miss to occur.
  • Create a central state repository for patients to report medical errors, making sure the reporting process is uncomplicated.
  • Develop an on-going, independent, random-sampling process to survey patients (and family members) who recently received care to document the prevalence and nature of medical errors. This is the most disruptive approach. From this collection process, state authorities, medical providers and the public will gain critical insight on the prevalence of medical errors, allowing for improvements. When errors are not reported and discussed, providers miss crucial feedback and learning opportunities.

The survey process can originate from claims data available through Medicare, Medicaid and private insurance companies. Patient experiences with medical errors can be collected and monitored for each medical provider, who would then receive systematic feedback about these errors to facilitate improvement processes. Through this data collection, results of medical errors would eventually be publicly reported for each institutional provider (e.g. hospital, surgery center, etc.).

A vast majority of Iowans have positive experiences with the healthcare system in Iowa. However, nearly one-in-five Iowa adults (18.8 percent) report having experienced a medical error either personally or with someone close to them during the past five years. Of those, 60 percent say they were not told by the responsible healthcare provider that an error had occurred. The survey found that hospitals were the most frequent site of medical errors (59 percent), while 30 percent of errors occurred in a doctor’s office or clinic, four percent in nursing homes and seven percent at some other location.

Among many important findings, the Iowa survey found that nearly 90 percent of Iowans “strongly agree” that healthcare providers should be required to tell patients about any medical errors. Additionally, 93 percent of Iowans “somewhat agree” (30 percent) or “strongly agree” (63 percent) the public should have access to medical-error information for each hospital and doctor.

Iowans feel strongly that medical errors must not be hidden from the public and should be reported, both to the patient and to an appropriate regulatory agency. Quality of healthcare will only improve when leadership, organizational culture and patient engagement are fully aligned. When seeking healthcare, patients deserve truthful, timely and transparent information about medical errors. Additionally, insurance companies can also contribute by embracing the safety of care their members receive from the medical providers included within their networks.

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Having the BHAG to shoot for the Moon

Did you know that up to 440,000 lives are lost annually in our hospitals due to preventable mistakes?

Because of this, we desperately need a Big, Harry, Audacious Goal (or BHAG) to solve this national tragedy, and it cannot happen soon enough. By the way, BHAG was a phrase coined by author Jim Collins.

On May 25, 1961, President John F. Kennedy addressed a joint session of Congress stating that the U.S. should set a goal of “landing a man on the moon and returning him safely to the earth” by the end of the decade. By making this bold statement, Kennedy captured the attention, imagination and collective will of our country. Eight years later, his BHAG was accomplished. Amazingly, we put a man on the moon using 1960’s technology.

In December 1999, the Institute of Medicine (IOM) released a seminal book, ‘To Err is Human: Building a Safer Health System.’ This book raised eyebrows and presumably generated supposed action. Using the annual estimate of 98,000 preventable hospital deaths, the IOM report attempted to galvanize this frightening number of avoidable deaths and set forth a worthy goal: “Given current knowledge about the magnitude of the problem, the (IOM) committee believes it would be irresponsible to expect anything less than a 50 percent reduction in errors over five years.”

Was the IOM goal reached in five years? No. In 15 years? Definitely not. Based on recent reports, preventable hospital deaths in the U.S. are greater than previously understood.

In 2013, the Journal of Patient Safety estimated that up to 440,000 lives may be lost annually in our hospitals due to preventable errors – over four times the number reported by the IOM. This equates to three jumbo jets falling from our sky EACH DAY, incurring 1,200 casualties. Another 10- to 20-times this number are seriously injured in our hospitals due to preventable errors. At best, we are making glacial progress.

Since the IOM report was released, the estimated number of lives lost due to hospital errors is alarming – between 1,470,000 and 6,600,000. Why such a chasm in numbers? Most errors go unreported for various egregious reasons. Our cobbled ‘system’ may kill as many people every eight days than were lost on 9/11 and in the Iraq and Afghanistan wars (9,469). Since 1999, more Americans have needlessly died in our hospitals than had died or were wounded throughout our entire history of wars (2.7 million).

‘To Err Is Human’ suggests that the problem is not bad people working in healthcare, but good people working in bad ‘systems.’ It is ironic that the very system we trust to ‘do no harm’ causes a great deal of lethal harm. Unlike actual jets falling from the sky, lives lost in our hospitals happen silently, one at a time. These fatal errors cannot be managed and improved if they are not first acknowledged and measured. Trust must be earned in healthcare, not blindly given. Without broad and consistent public outrage, this national tragedy will continue to persist with little hope of sustained improvement.

In our 2014 Iowa Employer Benefits Study, a top priority of Iowa employers is patients’ safety of care. Employers correctly perceive the safety issue has been inadequately addressed.

Because healthcare is local, solutions must be local. Hospital board members must insist that patient safety is paramount in setting their hospital’s long-term vision and mission. Their safety culture should permeate throughout the entire organization through policies, decision making, resource allocation, and most importantly, complete public transparency. Embracing this culture with words alone is nothing more than deceptive marketing fluff that silently kills.

If efforts to reach the moon were similar to how we confront safety of care, we would still be floating in boundless black space with little hope of reaching our destination. The BHAG we need in healthcare safety should be nothing short of landing on the moon by having the courageous willpower to get there – just like we did in the ’60s.

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Feeding Medicare’s Infrastructure

Mother Robin Feeds Young in NestMuch like a mother robin feeding her young, Medicare continues to ‘feed’ the infrastructure that serves our elderly – but, with a great deal of waste and inefficiency.

In their recent book, ‘Medicare Meltdown: How Wall Street and Washington are Ruining Medicare and How to Fix It,’ co-authors Rosemary Gibson (aka health care ‘rock star’) and Janardan Prasad Singh, spend a chapter on ‘Fifteen Medicare Facts That Will Astonish You.’ Learning astonishing facts can be fun. But when those facts relate to Medicare, they can be extremely sobering.

Perhaps you can use one or many of these facts to ‘wow’ guests at your next dinner party. Better yet, use them when meeting with those elected to Congress.

1. If Medicare were a country, it would be the 20th largest economy in the world.
That’s right, larger than the entire economy of Sweden – and double that of Ireland!

2. Medicare wastes the equivalent of New Zealand’s entire economy.
In 2011, Medicare spent $560 billion, yet about 30 percent ($170 billion) was wasted and did not benefit our seniors. Where did it go? Blame it on overtreatment, inefficiencies and poor management. (Source: Institute of Medicine)

3. Between now and 2030, Medicare will be adding population equivalents of Austria, Hong Kong, Israel and Switzerland to its rolls.
In 2013, about 49 million people were covered by Medicare, and in 17 years (2030), an estimated 33 million more Americans will be covered.

4. Ten thousand boomers sign up for Medicare every day.
That’s 10 thousand per day for the next 20 years!

5. During a lifetime of work, the average person pays $60,000 for Medicare.
Look at your pay stub, this is the money deducted for the Medicare payroll tax.

6. A new retiree can expect to receive about $180,000 in Medicare benefits.
A person pays in $60,000 and expects to receive, on average, $180,000 in benefits. Economics 101 can’t explain this type of math – unless we mortgage our future.

7. Your federal income taxes pay for a growing share of Medicare’s costs.
Subtract #5 above from #6 (answer: $120,000). From this amount, seniors pay for hospital outpatient care and doctor visits (Part B) and prescription drugs (Part D). The rest is paid by federal income taxes and borrowing – which raises the federal debt.

8. The number of corporate healthcare firms on the Fortune 100 list has increased from zero in 1965 to 15 today.
These firms have benefited greatly from the current Medicare infrastructure. According to Gibson and Singh, the ties that bind Wall Street and Washington in the healthcare industry are strong and their interests are often at odds with those of seniors and boomers.

9. The federal government borrows money from China to pay Medicare bills from hospitals, doctors and drug companies.
Currently, interest rates are low, but can (and will) change in the future. This is not good for our long-term debt problem.

10. President Obama and Rush Limbaugh agree on this fact.
Paying for Medicare is not sustainable at the rate these costs are growing.

11. Between now and 2035, the healthcare industry will reap from Medicare a larger share of the country’s gross domestic product.
As Medicare grows, the federal government will have less money to pay for the nation’s infrastructure, investments in science and technology, education and national security. According to the Congressional Budget Office, if we do nothing to curb this cost, Medicare will consume nearly 25 percent of the value of all goods and services our country produces by 2082. In 2006, Medicare spending was at three percent of GDP.

12. The number of doctors who specialize in caring for seniors is shrinking when more are needed.
The median salary for geriatricians is lower than almost all specialties, threatening the number of new doctors willing to fill this growing role.

13. Medicare’s money for hospital care begins to run out in 2024.
This fact about Medicare Part A comes from a non-partisan report by the Medicare trustees.

14. An estimated, 79,200 Medicare beneficiaries die each year because of preventable harm in hospitals.
This is just an estimate. We really don’t know because actual data of those fatally harmed is seldom reported on a consistent basis. Based on a 2013 report in the Journal of Patient Safety, this number could be much higher.

15. Annual Medicare fraud and abuse is equivalent to one million seniors’ lifetime Medicare contributions.
FBI fraud estimates can be up to 10 percent of what Medicare spends – about $60 billion. In addition, this amount does not include the mistakes made in coding payments and calculating the money Medicare owes to providers. In 2010, Medicare estimated $48 billion was made in ‘improper payments.’

‘Medicare Meltdown’ not only points out the problems but provides a road map on how Medicare can be fixed in the future. Much of what we need is the political willpower to make changes so that we can efficiently provide the necessary care to our seniors.

After all, a mother robin has only so much food to distribute.

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