Health system administration practices and frameworks

Health Systems Administration - Improving Patient Safety

Medical errors are responsible for the deaths of an estimated 48,000-98,000 patients each year. Such errors are estimated to cost more than $5 million per year in a large teaching hospital, and preventable health care-related cost the economy from $17 to $29 billion each year. Most errors arise out of incorrect prescription and delivery of medication, surgical errors, diagnostic inaccuracies, and system failures (AHRQ 00P058, April 2000).

One of the major changes that must take place if health care organizations are to succeed in reducing errors is a concerted effort to establish a culture of accountability, trust, system improvement and continuous learning. Such an attitudinal change needs to take place both at the industry and individual organizational level: "President Clinton has proposed nationwide mandatory reporting of medical errors...accountable." (CNN.com, May 2000)

The benefits of reporting have already been proven: "New York State now achieves 97% survival rates from coronary bypass surgery...." (New York Times Web site, February 2000) Inspite of this, one barrier in the way of such a change is the degree of commitment and support to the issue of full disclosure in preventing medical errors by hospital boards and trustees: "...a liability message...lock the file down and...sues you before the statue of limitations is over." (CNN.com, May 2000)

The second thrust area is that of system design given the mounting evidence that the vast majority of medical errors can be prevented by systems: "...safer by attending to three tasks: designing the system to prevent errors... procedures to make errors visible... may be intercepted... procedures for mitigating the adverse effects of errors when they are not detected and intercepted." (BMJ 2000, bmj.com) Examples of the benefits of system checks are double-checking of prescriptions and dosages or safety measures such as keeping antidotes to known drug reactions handy.

Systematic disciplines such as checklists and protocols will also go a long way in preventing mishaps: "...anesthesiologists... "practice parameters"... diagnosis, management, and treatment of specific clinical problems... The theory of high reliability organisations... model for performing highly hazardous activities with very low failure rates." (BMJ 2000, bmj.com) Another technique is the use of simulators for training to identify and prevent errors. Automation, too, has proven benefits. For example, computer entries eliminate errors that arise from illegible handwriting.