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December 1, 2009
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Sue Ducat

Ten Years After the IOM's Landmark Patient Safety Report, How Much Progress Has Been Made?

Bethesda, MD - Ten years ago today, the Institute of Medicine released To Err Is Human, a much-discussed report that launched the modern patient-safety movement. Evaluating what has been accomplished, Robert Wachter, author of two books on patient safety and editor of the federal government's two leading safety Web sites, gives efforts an overall grade of B-, a slight improvement from his grade of C+ when he performed a similar analysis five years ago. Wachter says that overall, the decade has seen progress in hospitals' responses to pressures (accreditation, regulation, and error reporting), but health information technology (IT) has lagged behind, with research in the area advancing, though underfunded.

Patient Safety at Ten: Unmistakable Progress, Troubling Gaps
by Robert M. Wachter

Robert M. Wachter is professor and associate chair in the Department of Medicine at the University of California, San Francisco.

In his analysis, Wachter looks at a multitude of categories. Some of the domains new to this report include: regulation/accreditation/reporting systems; health IT; malpractice system and accountability; workforce and training issues; research; patient engagement and involvement; provider organization leadership engagement; national and international organizational interventions; and payment system interventions. The highest grade, an A-, was given to organizational interventions thanks to what Wachter describes as stronger engagement by governmental and NGO interventions at the federal, state, and global levels. Several areas received grades of C+, including health IT, whose grade in 2004 was a higher B-, and where Wachter sees an almost static situation and "increasing evidence of health IT-related safety hazards and implementation challenges."

With funds directed in this area through the Obama stimulus package, Wachter anticipates future improvements in this area. Wachter cites several early missteps in the patient safety field, including the implementation of residency duty-hour reductions, without an attempt to improve procedures when residents sign out; and the national requirement to implement medication reconciliation in the absence of clear guidelines regarding how to accomplish this noble goal safely. Despite these setbacks, Wachter concludes that most changes have constituted real progress. "[E]ven our missteps...have yielded valuable lessons." Moreover, given the massive complexity of the health care system, he writes, "... had I been asked in 1999 how much change in patient safety-related areas would be possible within a decade, I would have substantially underestimated our actual accomplishments."


Health Affairs, published by Project HOPE, is the leading journal of health policy. The peer-reviewed journal appears bimonthly in print with additional online-only papers published weekly as Health Affairs Web Exclusives at www.healthaffairs.org.


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