The question of whether some number of mistakes is inevitable simply because human beings are fallible creatures is an important one. Systems thinking and improvement science operate under the assumption that human beings of course will always make mistakes ... which is why the systems in which they work need to be designed in ways that make it difficult for those mistakes to occur.
there are two "problems" with this idea: first, the absolute intolerance for
any error that is currently a byproduct of the medical tort system in this country, which is what systems-based practice is borne out of. second, when you rely on systems to prevent human error, the problem then becomes that the systems will ineluctably pose new, additional, systems-based avenues for error. i see this all the time in our institution, which relies heavily on computer-based and multiple layers of cross checks to prevent the "swiss cheese model" from happening. this often (yes, often) results in unnecessary delays in patient care, which themselves can be detrimental.
This idea conflicts directly with the bad apple theory, which insists that when a bad otucome occurs, it can always be traced to an individual or small group of individuals who are responsible.
the measure, in the end, is whether or not systems-facilitated practice saves lives, results in no change, or is worse than the current practice models. likewise, cost is an issue. furthermore, systems practice result in "blame diffusion", which one would think would minimized medical malpractice exposure. the opposite is often true, and merely creates more deep pockets for plaintiff's attorneys to try to get their hands into.
But if we grant that some errors will always occur, or that some bad outcomes will always happen in a system worked by humans, what is that number of errors or bad outcomes that we should accept? It's pretty tough, from a moral perspective, to come up with any number other than zero.
that's the problem in a nutshell, and you'd make a great plaintiff's attorney with that line of reasoning.
the fact is, we (meaning medical healthcare workers) did not make these patients sick. we did not tell them to develop a 80-pack-year smoking history. we did not force them to overeat. we did not put the genes in their bodies that cause them to have familial hypercholesterolemia or gout or von recklinhausen's disease (etc.).
the fact is that people are living longer, better, healthier lives - on the whole - than they have at ANY point in the history of mankind. why is this? not because the healthcare delivery model has gotten worse over time.
i agree that we can always be on a ramp of improvement with the way we do things. but, over 50,000 people die every year on the nations highways. why? "drinking and driving" you'd say. but, we don't put the onus of responsibility on the automobile makers, do we? they could build a car that you could drive 100 miles-per-hour head-on into a bridge abuttment, yet still walk away with a scratch. why don't we demand that they do this? cost! it's all about the benjamins, boys and girls.
our healthcare system is strained by people who's personally habits are out of control. we focus our efforts on trying to patch-together the lives of people who've adopted the sick role and have no real interest in getting better. then, many don't feel that they have to pay us for the services we render. or, an unanticipated outcome (not necessarily a medical error) arises from their unfortunate, often self-initiated, condition - and they want to immediately get a lawyer and sue us. isn't that incentive enough not to make a mistake? why give the lawyers more fodder for their medmal cannons?
i suggest that we stop beating up healthcare providers and suggesting that we are the ones always to blame for what's wrong with the healthcare delivery system. it starts a lot with the patients who refuse our advice, want to adopt and live in the sick role, and aren't interested in anything more than us providing them a quick fix so they can go back to their bad habits.
ours is an imperfect system, who's diagnostic and treatment models are based largely on averages, and no matter how much "fixing" is tried always will be. there's no excuse for the misadministration of a medication that results in harm to a patient. but, in all honesty, these types of errors will always happen no matter what systems you but in place, and remember that even now they are relatively uncommon in the grand scheme of things. expecting a "zero tolerance" policy will cost an exorbitant amount of money, money which imho could be better spent on education and prevention and, most importantly, research. who do you think these extra costs get passed onto anyway?
so, let's focus our main efforts on keeping these patients out of the hospital in the first place, and stop beating up doctors and nurses who're often overtaxed and unable to fully devote our attention to those patients who really need and want our care.
