November marks the 10-year anniversary of the Institute of Medicine's "To Err Is Human," the first of its 11-volume "Quality Chasm" series on improving patient care and avoiding mistakes.
Since the landmark report, health providers have been chagrined by the revelation that they were killing "a jumbo jet" full of passengers every day, about 98,000 preventable deaths a year. And many of them reacted to the allegation by launching a broad spectrum of efforts to reduce medical mistakes.
But are we really better today at preventing mistakes and safeguarding our systems from causing harm than we were 10 years ago?
"We're safer in many more places, and more of the time," says James Conway, senior vice president of the Institute for Healthcare Improvement in Cambridge, MA.
"We're seeing very courageous people in many organizations doing exceptional work. We're seeing sobering discussions about the circumstances in which patients died unnecessarily, confronting the reality of the patient who was harmed with graphic detail, using the name of the patient, and their age."
There is in many places, Conway says, more accountability and more responsibility. There is more acknowledgment that mistakes are preventable, and not just part of the background noise that says it's OK because bad things happen in medicine sometimes.
But on a national level, he's not so sure. He's concerned that in many regions, facilities have not become "expert at looking for trouble. We're just learning to identify what harm is," he says.
First the good news.
Providers are setting goals for their communities. Hospitals are starting to use the IHI "global trigger tool" to more accurately measure areas of care that might be causing avoidable harm, including the 28 adverse events now required to be reported.
But many significant challenges remain.
On the negative side, lots of serious mistakes are still happening. Earlier this month for example, Rhode Island Hospital, the state's largest, was fined $150,000 for performing its fifth wrong-site surgery since 2007. The latest incident prompted the state to order the facility to install video cameras in all its operating rooms.