Are you a white-knuckle flier? My sympathy. Planes are scary and dangerous. But let’s see: In the last 10 years, a passenger has stepped onto a U.S. airline about 7 billion times. How many of those 7 billion times did the passenger survive? Not counting 9/11, all but 438. Those are actually pretty good odds – 438 out of 7 billion. There has not been a fatal crash on a major U.S. carrier for seven years.
Then there are hospitals.
The famous Institute of Medicine (IOM) study ("To Err Is Human" 2000) found 44,000 to 98,000 premature deaths every year due to medical error. A 2006 IOM study found that a patient in a U.S. hospital suffers, on average, one drug mistake a day. When the Kaiser Family Fund asked patients, in 2003, whether they feared for their safety in healthcare environments, 47% said they were "very concerned" – while only 32% said they felt that unsafe when they flew on an airplane.
Now Blue Cross/Blue Shield organizations in some states, Aetna, and (starting in October) Medicare are all saying that they are not doing to pay for "never events," such as the $50,000 it can take to retrieve a sponge left in a surgical patient.
"Never events" are wonderful things to try to explain to your average civilian. Yes, they are called "never events" because they are literally never supposed to happen. Yes, they happen often enough that we have a name for them in the industry, and statistical categories, and payment policies. They always want to know: How many are there? And how bad are they? Nobody knows how many there are, because there is no canonical definition. But Minnesota tallied 125 of them in a year starting in October 2006. How bad were they? They included (for example) patient kidnapping and sexual assault, giving a baby to the wrong person, operating on the wrong body part or the wrong patient, or the wrong procedure; and burns, falls, and drug mistakes leading to death or serious disability. One hundred twenty-five of them.
Is this an IQ problem? Not at all. Like almost all patient safety problems, the tally of "never events" is not a picture of rampant stupidity, laziness, or evil intent. It's a picture of very smart people operating under pressure, without adequate systems in place.
What do I mean by "systems?" Are we talking high tech? Sometimes. Studies show that instituting digital order-entry eliminates some 86% of drug mistakes. But just as often it's not high tech at all. For instance, many surgeons have taken to writing the basic surgical instructions ("Cut here") on the patient in indelible ink before the operation, during the patient consultation. It's hard to cut off the wrong leg when the correct one has a big dotted line across it.
What it takes mainly is a change in attitude, a willingness to admit that mistakes happen, a willingness to ask (systematically, formally, and repeatedly) the people involved in delivering the care (whatever their rank in the system) how to improve safety – and to listen, and to implement their recommendations. It is a willingness, as well, to make safety guidelines mandatory, and a consistent disregard for them a firing offense, just as it would be in any other industry. Maybe then it would be as safe to go in a hospital for a routine appointment as it is to take a routine flight.