HEALTH CARE QUALITY
AND SAFETY: BEHIND THE
BUZZWORDS
Hugh W. Shoff, MD, MS
W
e hear the words all the time.
The government, administration, colleagues and even our
patients speak them. They have become synonymous with improvement projects, medical errors and health care costs. They are the
words “quality and safety,” and you can’t walk
through the hospital without hearing one or
both of them.
The catalyst for the push to higher quality and safer care for our patients began in 1999 when the Institute of Medicine (IOM) released
its report “To Err is Human.” In that report, it was estimated that
44,000 to 98,000 deaths each year could be attributed to avoidable
medical errors. At that time, medical errors placed 8th on the list
of top causes of death. In a 2001 follow-up report (“Crossing the
Quality Chasm"), the IOM laid out six aims on which we should
focus our improvement: safe, effective, patient-centered, timely,
efficient, and equitable … care. These aims were developed to guide
improvement in our health care system. For the IOM, they are the
pillars on which we could build a safer system.
Fifteen years after the IOM’s second report we may not be making
significant strides. In a recent article published in the BMJ, Martin
Makary and Michael Daniel at Johns Hopkins School of Medicine
10
LOUISVILLE MEDICINE
estimate that our current rate of death due to medical errors falls
between 210,000 and 400,000 deaths per year. Extrapolating data
from 1999 to 2013, they estimate a mean death rate of 251,4