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.

New Call for Submissions ­to NEJM Catalyst

Connect

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

Learn More »

More From Leadership
East London NHS Foundation Trust Non-Clinical Quality Improvement Days Taken to Complete Disciplinary Process

Quality Improvement for Non-Clinical Teams

Administrative QI projects save money, streamline processes, and even improve patient care for the U.K.’s National Health Service.

Physician Clinician Burnout Is Extensive

Leadership Survey: Immunization Against Burnout

Clinician burnout is far from being eliminated at health care organizations, but leaders, frontline physicians, and nurses are joining forces to get to the roots of the crisis.

Fleisher03_pullquote Physicians-in-Training - An Untapped Resource for Health Care Innovation

Physicians-in-Training: An Untapped Resource for Health Care Innovation

Five strategies that can support long-term leadership development and open opportunities for system transformation.

Tait Shanafelt

Beyond Burnout — Redesigning Care to Restore Meaning and Sanity for Physicians

There’s a growing recognition that organizations need to redesign the way that clinical care is delivered to address the national physician burnout epidemic. Measuring rates of physician burnout is the first step.

Sample Testimonials from Fresh Eyes Action Learning Program

Action Learning–Based Leadership Development at an Academic Medical Center

How Mayo Clinic utilized an action learning–based program to foster the leadership skills needed to navigate the changing landscape of health care.

Many Different Definitions of Stakeholder Alignment in a Health Care Organization

Leadership Survey: Why Big Gaps in Organizational Alignment Matter

An NEJM Catalyst Insights Council survey finds that clinicians and leaders do not see eye-to-eye on many aspects of health care delivery.

Physician Coaching Models Interview Large Headshots - Rana Awdish Dale Glenn Ghazala Sharieff Tom Howell Namita Seth Mohta

Physician Coaching Models: Solutions and Impediments

A group of care experience leaders from across the United States discuss innovative physician coaching models at their respective organizations.

University of Utah Family Medicine Residency Program Value Improvement Projects - Practice-Based Learning and Improvement PBLI Milestones Score by Year of Residency

How the University of Utah Prepares Family Medicine Residents to Lead Value Improvement Efforts

A rigorous 3-year program helps physicians focus on improvement through interprofessional collaboration.

Integrating Product Management Education into Health Care - Example of How Curriculum Would Help Physician Tackle Clinical Need in Tandem with Engineer and Business Lead

The Case for Product Management Education in Clinical Training

How can physicians learn to speak the language of innovation and claim a role for themselves within the innovation ecosystem?

Della Lin picture

Lessons in Leadership: Della Lin

How lessons from a concert pianist in timing, audience connection, and intent apply to health care leadership.

Connect

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

Learn More »

Topics

Physician Burnout

34 Articles

Leadership Survey: Immunization Against Burnout

Clinician burnout is far from being eliminated at health care organizations, but leaders, frontline physicians,…

Leading Transformation

193 Articles

Amazon and CVS: Short-Lived Unicorns in…

Will Amazon–Berkshire Hathaway–JP Morgan and CVS-Aetna change the health care game? To one health care…

Leading Teams

130 Articles

Action Learning–Based Leadership Development at an…

How Mayo Clinic utilized an action learning–based program to foster the leadership skills needed to…

Insights Council

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

Apply Now