Three Ways to Prevent Medical Errors

"Perfect safety, by the way, doesn't mean eliminating all mistakes. It means structuring a system that expects and safely deals with mistakes. That's the essence of a high-reliability organization."

So says Dr. Jack Silverman, a fictional hospital administrator in John Nance's landmark book Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care, published in 2009. In the book, Nance, an expert in aviation safety, describes a fictional hospital that draws on airline industry safety techniques to enhance patient safety. 

Concerns about the growing prevalence of medical errors in US healthcare were first raised in 1999 when the Institute of Medicine published the report "To Err is Human." Like Why Hospitals Should Fly, the report asserts that "the problem is not bad people in health care--it is that good people are working in bad systems that need to be made safer." The report examines the impact of legislation, regulation, and market activity on care quality.

Twenty-three years after this landmark report, healthcare organizations use Why Hospitals Should Fly as a training manual for patient safety initiatives. Medical checklists are now widely used. Unfortunately, medical errors continue to compromise US healthcare delivery. According to a 2019 review and meta-analysis published in the BMJ, about 1 in 20 patients are exposed to preventable harm in medical care.

Safety protocols and safety culture play essential roles in reducing medical errors. However, the impact of addressing systemic issues compromising the safety of American patients shouldn't be underestimated. The following are three ways to minimize mistakes through a systemic approach.

1. Prioritize continuity of care

Continuity of care and care coordination are sometimes used interchangeably, but care coordination is just one aspect of continuity. Care coordination facilitates collaboration, communication, and information-sharing between all providers involved in a patient's care. 

Care coordination is not, however, a stand-alone substitute for solid provider-patient relationships. Like any relationship, the bond between primary care physicians and their patients takes time to develop. Ideally, the Primary Care Provider (PCP) should see each patient several times a year, especially with older populations. The patient should be able to contact their provider easily and always have access to medical support via the practice. 

Investing this level of time and resources into building provider-patient bonds creates meaningful continuity of care. In a system that centers the relationship between the patient, the provider, and the practice, PCPs can genuinely get to know their patients. Medication and diagnostic accuracy are supported by this scenario, while incorporating personal preferences and values into care decisions can help avoid other negative consequences.

Sometimes, preventing a medical error comes down to recognizing something unusual in the patient's behavior, speech, or appearance. A doctor cannot capture that degree of personal understanding in notes or EHR records.

2. Create a culture of communication

Communication can prevent errors, remediate errors, and contribute to changes that minimize mistakes. Creating a collaborative, respectful environment within healthcare organizations fosters good clinician communication. Acknowledging that mistakes happen and building communication strategies into staff training can go a long way toward protecting patients from preventable harm. 

For example, imagine a nurse struggling to decipher the iconic, illegible doctor's handwriting on an IV order. If the organization has a fast-paced, hierarchical culture, the nurse might feel unsafe asking the doctor for clarification. Instead of determining the correct dose, the nurse goes with her best guess, resulting in a medication error that could potentially cause harm or even death.

Now imagine the same scenario in an organization that treats all staff as valuable team members. Physicians, nurses, techs, and administrative staff all work toward the same goal, prioritizing patient safety. In this case, the nurse feels comfortable confirming the dosage with the doctor, eliminating the risk of a serious medication error. 

3. Reduce hospitalizations through prevention

The risk of dying after hospitalization has decreased, according to the most recent data from Leapfrog. But errors, accidents, injuries, and infections still claim the lives of 160,000 hospitalized patients each year. Keeping patients out of the hospital altogether eliminates this particular risk. 

Much research, such as this 2018 study, shows that primary care, with its focus on prevention and care continuity, is associated with reduced expenditures and a lower hospitalization rate. A 2011-2018 study of a German primary care program also found that care continuity had the most impact on higher-risk patients–who are also more vulnerable to hospital-related errors.

Of course, hospitals play a vital role in healthcare, and some conditions unequivocally require surgery or hospital time. The opportunity for hospital errors is reduced when PCPs check in on their patients and communicate regularly with the hospital clinicians. The PCP cannot replace specialist care, but they contribute their knowledge of the individual patient and whole-body medicine to the overall picture. That vital information could help prevent patient harm and enhance care quality.

Why a full-risk model is safer for patients

The full-risk model allows primary care providers to practice at their best. ChenMed's physicians have smaller patient panels and longer appointment times than PCPs in the fee-for-service model. We see our patients several times a year; most of the time, our patients see the same doctor. We specialize in knowing and understanding our patients as whole people. This doesn't mean that we never have to rely on specialist expertise. But we take responsibility and accountability for the patient and work with them regarding what matters to them, not just what's the matter with them.

The transformative primary care approach minimizes the "moral injury" associated with physician burnout. The transformative process supports a broad range of care needs, so the physician has options. The PCP can extend care beyond the clinic, like sending a nurse to a patient's home to help them sort through their medications or having a team member set up food delivery. Those options mean physicians can make a significant impact on patients' lives. This adds to better job satisfaction, reduced stress, and fewer medical errors. 

As quoted in Why Hospitals Should Fly, the visionary architect and design theorist Buckminster Fuller famously said, "you never change something by fighting the existing reality. To change something, build a new model that makes the existing model obsolete." This serves as an excellent motto for improving patient safety. ChenMed's unique approach to care aims to establish a new system that elevates continuity of care in alignment with the patient's individual needs that integrates with all aspects of healthcare delivery.

ChenMed’s transformative primary care promises a better health care future—for patients and providers. If this approach to patient care appeals to you, we invite you to learn more about growing your career at ChenMed.