In the 21 years since the National Academy of Medicine published To Err is Human, there has been significant effort to improve safety and reduce the variation in health outcomes in the United States. Still, an estimated 1.2 million are harmed each year by medical errors made in U.S. hospitals. We outline below necessary steps to change this.
Even in geographies that have a reputation for high quality care (such as metropolitan Boston and metropolitan New York) there is a five times greater chance of death from acute myocardial infarction (heart attack), depending on the hospital one chooses. Across the United States, on average, patients are twice as likely to die in the lowest-performing hospitals. This includes a 2.3-fold difference in heart attack mortalities. There are even greater differences in safety. The top 10% of hospitals are 10 times safer than bottom 10%. Patients are 18 times more likely to suffer a bloodstream infection from a central venous catheter when treated at poor-performing hospitals.
Existing processes such as Joint Commission Surveys, surprise reviews by the Centers for Medicare & Medicaid Services (CMS), internal improvement processes, and retrospective public reporting of safety by government and public entities have not worked to reduce variation.
Why do these risks and variations persist?