MEDICAL MISHAPS AS SYSTEM FAILURES

Post lifted from the Adam Smith blog

Star speaker at the Adam Smith Institute House of Commons breakfast yesterday was Sir Liam Donaldson, the NHS Chief Medical Officer, talking about patient safety. Though the papers (and lawyers) seem to like to go after individual doctors when mistakes happen, Donaldson's view is that most of the problem is down to human error right enough, but human error in a weak system.

"Patient safety has not been a priority," he told the 60 or so guests, senior figures from private and public healthcare, journalism and politics. "Control systems are too weak for the high-risk industry that we are in." They just wouldn't be allowed in transport, for example - 2004 was the safest year in airline history, and 2005 looks like ending up even safer. In 2000, the NHS killed more people through infusion pump errors than died in the Hatfield crash that year: the difference is that Hatfield led to huge changes in safety procedures.

Bad teamwork and poor communication with patients and other healthcare professionals both kill patients. But traditionally, doctors have seen their role as applying medical knowledge, and have not regarded communication and teamwork as core skills. That at least is now changing, said Sir Liam.

But he was still skeptical about the way that medical accidents are dealt with. The General Medical Council, the Crown Prosecution Service and the media always like to pin the blame on specific doctors, when really it is NHS systems that are to blame. And most official inquiries into medical accident "result in no learning whatsoever" because few take a systems view of the problem.

So it's not surprising that doctors are reluctant to report accidents or near-misses. But I think that we would have much more confident in our doctors if they did - a point confirmed by another speaker, Jim Johnson of the Dana-Faber Cancer Institute in Boston. "We listed all our mistakes over the last decade in the Boston Globe," he said. "It actually made our competitors angry, because everyone thought, if we are big enough to own up to our mistakes, we've probably made efforts to fix things, and we're probably safer than everyone else." A lesson for doctors here, perhaps?





Too many choices : "The new Medicare prescription drug plan will save senior citizens billions of dollars, so why are so many of them afraid to sign up for it? You wouldn't think such a beneficent program would have to put a metaphorical gun to people's heads (in the form of a 1 percent per month premium penalty) to get them to enroll now. Yet that is what seems to be happening. Senior citizens are confused. The government has turned the insurance companies loose, with the result that in some states there are more than 50 plans to choose from -- all of them complicated -- and nowhere is there a simple metric that people can use to determine which plan is best for them. Befuddled seniors are clutching their heads and asking someone, anyone (their pharmacists, their kids, AARP) for help."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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