The British Medical Journal has devoted most of one issue to the problem of medical error and patient safety. The March 18 BMJ includes five leading articles, five research papers, a clinical review and nine "education and debate" articles - all on aspects of error reduction and safety improvement.
Explaining the choice of theme, the journal refers to a United States study indicating that about 100,000 Americans a year die from preventable errors in hospitals - more than the combined number of deaths and injuries from motor and air crashes, suicides, falls, poisonings and drownings.
One leading article says that health care refuses to accept what other hazardous industries recognised long ago: that safe performance cannot be expected from workers who are sleep deprived, who work exceedingly long hours or whose job designs involve multiple competing urgent priorities.
Another editorial points out that the health professional responsible for a medical error becomes the second victim of the error. Even when errors are built into existing routines and devices, the unwitting practitioner may be judged incompetent and treated unsympathetically by his or her peers. The article adds that, given the hospital hierarchy, nurses, pharmacists and other members of the health care team have less latitude to deal with their mistakes than do physicians.
The BMJ says that, as several articles make clear, the correct response to an error is not to concentrate on blaming those who made the mistake but to redesign systems so that errors are acknowledged, detected, intercepted and mitigated. Leaders should recognise that most medical errors are not due to negligence by individuals but arise from poorly designed processes and systems of care.