December 28, 1999
Progress on Medical Errors
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he Department of Veterans Affairs recently
reported that veterans' hospitals around the country committed about 3,000 medical errors leading to
about 700 deaths between June 1997 and December
1998. These frightening statistics reflect what can
go wrong in the veterans' health system.
But they
also reflect what is being done right.
Veterans' hospitals are not the only ones
plagued by mistakes. The Institute of Medicine
reported last month that medical mistakes kill
more hospital patients than car accidents, AIDS or
breast cancer. The report goaded politicians to
promise corrective action, and last week eight
executives of major companies disclosed the formation of an organization -- the Leapfrog Group --
designed in part to steer employees to hospitals that
make the fewest mistakes.
The veterans' hospitals had already begun
putting error-catching systems in place before the
institute's report was released. When Dr. Kenneth
Kizer took over as under secretary of veterans
affairs in 1994, he found an unorganized health
system lacking modern quality control or standards. The system had a reputation for bloated costs
and sometimes substandard care.
Dr. Kizer brought hospitals, outpatient clinics
and nursing homes together into integrated networks. He paid the networks a fixed amount of
money for each veteran the network treated independent of the diagnosis, giving them a powerful
incentive to spend money wisely.
The doctors were
paid salaries, eliminating any economic reason to
under-treat or over-treat patients. Dr. Kizer closed
hospitals and eliminated administrators.
"The Veterans Health Administration has
made a more serious commitment to improving
health safety than any other large system in the
country," said Dr. Donald Berwick of the Institute
for Healthcare Improvement, a nonprofit research
center in Boston.
Beyond structural reforms, Dr. Kizer initiated a
policy that requires employees of the veterans'
health system to report medical errors. This policy
produced the data on thousands of mistakes and
hundreds of deaths over 19 months. There is no
evidence that the veterans' hospitals are treating
patients less safely than other institutions are, Dr.
Berwick said.
He argues that private hospitals
would look just as bad if they reported medical
errors as accurately.
The first step in overcoming errors is to report
them accurately. The data from the veterans' hospitals, as grim as they are, reflect the fact that the
system is moving in the right direction.
