Leadership

Preventable Deaths in American Hospitals

Article · January 23, 2017

Hospital medical errors are the third leading cause of death in the United States. That’s 700 people per day, notes Steve Swensen. “And most of those have a second victim: the nurses, doctors, social workers, managers, pharmacists involved in their care.”

How big of a factor is this victimization? And what can we do to prevent this tragedy, apart from addressing the cause of the preventable death?

In a Mayo Clinic study with the American College of Surgeons, 8.9% of participating U.S. surgeons reported the belief that they’ve made a major medical error within the last 3 months — and 1.5% believe their error resulted in a patient’s death, according to Tait Shanafelt. “When you think about that for a minute, it’s a staggering number,” Shanafelt says. Suicide ideation doubles in that 3-month window as well, he notes, independent of depression — the risk of which triples. “So when we make mistakes — and all physicians will make mistakes during the course of their career — it has a substantial toll on us. And there’s a strong link there with burnout.”

How do we mitigate that? By having a community of colleagues who support each other. “I just don’t think that people who are not physicians or not in the medical field can really fully understand what that experience is like for a surgeon who believes they’ve made such a mistake, with the exception of their colleagues,” says Shanafelt. “And so those communities need to be built ahead of time.” Mayo Clinic, for example, pays for its physicians to periodically go out for meals together.

Physicians are also often reluctant to seek mental health care for depression and suicidal ideation out of concern it will prevent them from renewing their license. Well-intentioned state licensing boards may ask appropriate questions such as, “Do you have a physical or mental health condition currently that impairs your ability to practice with skill and safety?” Or they may ask fairly draconian questions: “Have you ever experienced depression or been treated for depression at any point during your life?” The latter question has nothing to do with current conditions and impairment, explains Shanafelt, causing many physicians to self-prescribe antidepressants rather than seek care. We need to improve the way we’re asking these questions.

Christine Sinsky adds that, according to a Rand Corporation study, many things, such as EMRs, get in the physician’s way of delivering the best patient care, ultimately leading to physician dissatisfaction. “We have a very hazardous information environment that we’re working in, that well-intended, very potentially powerful tools are still somewhat immature and in unexpected ways have made care more hazardous,” explains Sinsky. We need to protect patients — and physicians — while in “this area of information overload, information underload, information chaos”.

Watch the video:

From the NEJM Catalyst event Leadership: Translating Challenge to Success at Mayo Clinic, June 2, 2016.

Call for submissions:

Now inviting expert articles, longform articles, and case studies for peer review

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From Leadership
Action Steps for Risk-Share Contracts for Medical Devices

Challenges and Best Practices for Health Systems to Consider When Implementing Risk-Share Contracts for Medical Devices

When done right, value-based contracting for medical devices can ameliorate shrinking margins at health systems, leading to a virtuous circle.

Health Care Organizational Culture Emphasizes Patient Care Only Slightly More Than the Bottom Line

Survey Snapshot: Who Should Lead Culture Change?

NEJM Catalyst Insights Council members feel that culture change at their organizations is heading in the right direction, but differ on who it should come from, and reveal too much balance between emphasis on bottom line and emphasis on patient care.

Culture Change Within Health Care Organizations Is Changing for the Better

Leadership Survey: Organizational Culture Is the Key to Better Health Care

Although three-quarters of Insights Council survey respondents say culture change is a high or moderate priority at their organizations, survey results show a lot of work on organizational culture remains to be done.

Metraux01_pullquote - dinners to combat burnout in the health care community

“Breaking Bread” to Combat Burnout

Can a simple dinner create community among health care providers?

IHI HPMS Visual Management Board Example

The Answer to Culture Change: Everyday Management Tactics

Adoption of a clear rhythm-of-performance measurement and communication via huddles and visual management can affect a culture of staff engagement and continuous value improvement.

ajor Themes from Cleveland Clinic Town Halls 2016

Reigniting the Passion to Practice Through a Multi-Pronged Approach

Cleveland Clinic formed the Practice Innovation and Professional Fulfillment Office to create and sustain an environment that allows clinicians and scientists to thrive through barrier removal, culture change, and support for personal well-being.

Percent in Highest Bracket in Patient Satisfaction Scores - Pre-Post Arm Differences for Hospitalists - Duke Coaching Communication Skills Study

Coach, Don’t Just Teach

The effect of one-on-one communication coaching on clinicians’ communication skills and patients’ satisfaction.

Two-Thirds of Organizations Have a Nurse Leader Career Path

Survey Snapshot: Do Nurse Leaders Need Advanced Degrees?

Though NEJM Catalyst Insights Council members acknowledge a lack of advancement opportunities for nurse leaders, two-thirds of their organizations have a nurse leader career path.

Nurse Leaders and Physician Leaders Should Be Considered Equals in Care Delivery - but Views of Nurses and Non-Nurses Differ

Leadership Survey: Nurses as Leaders: Broad Acceptance, Room to Grow

Nurses are traditionally the backbone of patient care. They form the largest percentage of the health care workforce, far outstripping physicians. But are nurses leaders as well as doers?

The CMO Role of the Future - Baptist Health Survey Results

Examining the Continuously Evolving Role of the Chief Medical Officer

Hospital and system leaders need to sharpen the focus of CMO roles to include system-wide considerations beyond the walls of the hospital.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Physician Burnout

45 Articles

“Breaking Bread” to Combat Burnout

Can a simple dinner create community among health care providers?

Leading Transformation

264 Articles

Finding the Cause of the Crises:…

Until we redesign our health care system to address our patients’ personal determinants of health,…

Leading Teams

164 Articles

Survey Snapshot: Who Should Lead Culture…

NEJM Catalyst Insights Council members feel that culture change at their organizations is heading in…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now