Safety & Risk in Practice

The medical profession has no place for its mistakes. Yet mistakes do occur, and the simplistic view that there can be no error without negligence is inadequate. In an impressive and thoughtful article Lucian Leape touches the nucleus of the problem that health care has in dealing with errors. In Anglo-American literature the threat of malpractice litigation is often the motive for analyzing errors and accidents. But Dr. Leape, one of the investigators involved in the Harvard Medical Practice Study of errors and iatrogenic damage in hospitals (1990), offers a positive approach to the backside of quality. The starting point is that mistakes and errors are inevitable, in health care as in other fields. If we can accept that errors will always occur, it becomes a challenge to use the experience derived from them for preventing accidents. In an editorial David Blumenthal calls this the paradox of modern quality improvement. Only by admitting and forgiving errors can their incidence be reduced. But is the medical profession willing to transform medical errors into medical treasures? The answer is disappointing. The profession shows (with rare exceptions) an ostrich-like attitude. In contrast to what has happened in high-technology industry and in aviation, the relatively high error and accident rate in health care has not stimulated more concern or greater efforts at error prevention. Health care providers have difficulties in dealing with human error. In education and daily practice physicians and nurses simply learn to regard mistakes as unacceptable. Errors are associated with personal failures; fallible doctors are considered incompetent. Processes of socialisation play a role in constituting this attitude. The profession has developed unattainable standards