Factors That Affect Medical Errors

INTRODUCTION The main objective of healthcare professionals is to provide the best quality of patient care and the highest level of patient safety. To achieve that objective, there are many organizations that help improve the quality of care. One of the best examples is the Joint Commission. Unfortunately, the healthcare system is not free from total risks. In healthcare activities, there are possible errors, mistakes, near miss and adverse events. All of those negative events are preventable. But, it is clear that errors caused in healthcare result in thousands of deaths in the United States.

IOM Report To Err is Human Over a decade ago, the Institute of Medicine (IOM) published a report that startled the healthcare profession and shook up the public on a national and global level. IOM’s report To Err is Human (IOM, 1999), revealed the astronomical number of patient lives lost due to preventable and avoidable patient care errors (IOM, 1999). The IOM report begins with the blunt statement, “health care in the United States is not as safe as it should be—and can be” (IOM, 1999, p. 1). The report reveals at least 44,000 individuals and as many as 98,000 individuals die in hospitals every year due to preventable medical errors (IOM, 1999).

One of the most critical factors which contribute to the number of preventable cases of healthcare harm is the culture of silence surrounding these cases. The fear of medical providers to report incidences is related to the possibility of punishment and liability due to a medical error (Discovery, 2010). The criminalization of some acts of medical error has resulted in job dismissal, criminal charges and jail time for some healthcare workers. This is despite the fact that the system they are working in helped to create the situation which led to the error in the first place. Human error, due to fatigue and system errors can result in deadly consequences, but by criminalizing the error it effectively shuts down the ability to correct the root problem. Healthcare workers, working at all levels within the medical system, can provide valuable input on how to improve the processes and prevent harm from occurring (Discovery, 2010).

Introduction Keeping patients safe is essential in today’s health care system, but patient safety events that violate that safety are increasing each year. It was only recently, that the focus on patient safety was reinforced by a report prepared by Institute of medicine (IOM) entitled ” To err is human, building a safer health system”(Wakefield & Iliffe,2002).This report found that approx-imately 44,000 to 98,000 deaths occur each year due to medical errors and that the majority was preventable. Deaths due to medical errors exceed deaths due to many other causes such as like HIV infections, breast cancer and even traffic accidents (Wakefield & Iliffe, 2002). After this IOM reports, President Clinton established quality interagency

Background It is shocking to know that every year 98000 patients die from medical errors that can be prevented(Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.), 2000). Medical errors are not a new issue in our healthcare system; these have been around for a long time. Hospitals have been trying to improve quality care and patients safety by implementing different strategies to prevent and reduce medical errors for past thirty years. Medical errors are the third leading cause of death after heart disease and cancer in America (Allen, 2013). In addition medical errors are costing our healthcare system an estimated $735 billion to $980 billion (Andel, Davidow, Hollander, & Moreno, 2012).

Human factors With the new healthcare landscape, quality improvement has become a priority; and as required by current legislation, quality initiatives need to be implemented, monitored, and reported (Ransom, Joshi, & Nash, 2008). According to Dattilo and Constantino (2006), human factors play an important role in most errors despite the existence of other root causes. For example, short staffing, shift overlapping, staff level of training and qualifications, close supervision, and overall team and staff culture are all factors that may be the trigger points

Contraindicated care and health care related mistakes harm millions patients and contribute to the overall cost of health care. According to the HRSA’s 2012 annual report to congress: “National Strategy for Quality Improvement in Health Care” (U.S. Department of Health and Human Services ) which cited the following examples of health care related mistakes:

II. Background Each year medical errors cause more than 400,000 American deaths and at least 10-20 times that number experience serious harm. Researchers say that is equivalent to “three 747 airplanes crashing each day.” Medical errors rank as the third-leading cause of death in America. Therefore, patient safety is a national concern.

Problem Statement: It is critical in today’s health care field to avoid harm and ensure that patient safety in health care environment, especially with the attention of medical mistakes little is known about the importance of avoidable harm to public. The mistakes that happen in the healthcare setting are rarely the fault of individual workers, but usually the result of problems within the system that they work.

Millions of Americans surrender to conditions that are both preventable and manageable annually. Besides chronic diseases, researchers have identified that the third leading cause of death in America is the errors conducted by professional medical practitioners. While medicine is a highly considered field, some of the practices that contribute to the errors observed include the absence of patient safety, poorly coordinated care, and inefficient healthcare quality improvement. Significant steps that can be taken to reduce deaths caused by medical errors include good communication, cooperation, use of advanced technology and implementation of quality healthcare among

Quality of Care: Six Aims Evaluation Kristel Mabry Horry-Georgetown Technical College The Institute of Medicine released a report in 1999 titled To Err is Human: Building a Safer Health Care System concerning the number of medical error related deaths. The report states that between 44,000 and 98,000 medical error related deaths occur each year in hospitals across the country (Kohn, L. T., Corrigan, J., & Donaldson, M. S., 2000) In response to this report, the Institute of Medicine released Crossing the Quality Chasm: Health: A New Health Care System for the 21st Century that outlines six aims for the future of the healthcare system: safe, effective, patient-centered, timely, efficient, equitable (Institute of Medicine, 2001). These aims set to establish the quality of healthcare across the country. Quality is defined by the Institute of Medicine as ““the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (2001).

According to the Institute of Medicine (IOM) report, To Err Is Human, the majority of medical errors result from faulty systems and processes, not individuals (Hughes, 2008). However, due to processes that are inefficient and variable, multiple health insurance, differences in provider education and experience, and other factors that contribute to the complexity of health care the IOM has put together six aims of health care that is effective, safe, patient-centered, timely, efficient, and equitable (Hughes, 2008).

Background Many health care leaders, authors, and professionals have given their time and effort to write and discuss quality. Quality is now recognized as one of the key aims in healthcare today. The Institute of Medicine (IOM) has had a profound impact on health care in America and the view of

Organizational Responsibility & Current Health Care Issues HCS - 545 11/19/2012 Organizational Responsibility & Current Health Care Issues In today's modern world with plenty of technology, it is hard to believe that we cannot figure out how to reduce Medical errors. The issue of medical error is not new in health care organizations. It has been in spot light since 1990's, when government did research on sudden increase in number of death in the hospitals. According to Lester, H., & Tritter, J. (2001), "Medical error is an actual or potential serious lapse in the standard of care provided to a patient, or harm caused to a patient through the performance of a health service or health care professional." Medical errors

Imagine you are injured or sick and have sought a doctor’s help. Although you trusted your doctor, something, something seemingly very in control of the doctor, went wrong. You are angry and confused, but also think of the commonality of medical malpractice. So, why do doctors, who are supposed to