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
Framework for Comprehensive Community Wellness

A Vision for Upending the Siloed Status Quo

A five-point plan unveils ways that leaders of health care and public health organizations can take action to enhance community wellness.

Mangi01_pullquote - patient flow dynamic work design

Improving Patient Flow with Dynamic Work Design

Staff make big improvements in post-operative care by changing small details.

Lerman01_pullquote leadership development

Leadership Development in Medicine

It is time for a critical assessment of the ways in which health systems develop, select, and support emerging physician leaders.

Perlo01_pullquote community organizing principles for restoring joy in work in health care

Applying Community Organizing Principles to Restore Joy in Work

IHI offers four lessons on how to nurture joy in the health care workforce.

MHCM Physician Leaders Career Paths Post-Graduation

Physician Leader Training: The Value, Impact, and Challenges

Alumni of Harvard’s postgraduate Master in Health Care Management degree program reveal the benefits of academic training, and the real-world challenges for new clinical leaders that can lead to success as well as frustration.

Nurok02_pullquote - physician-hero - team-based care

The Adverse Impact of the Physician-Hero

In a value-based world, the sickest patients need the benefit of a comprehensive team to provide evidence-based treatment that will deliver desirable clinical outcomes while optimizing the cost of care.

Patel01_pullquote - interprofessional education and collaboration

Interprofessional Collaboration for a Health System in Crisis

To overcome current failures within our health systems, we need to improve interprofessional education and collaboration.

Tina Freese Decker

Cultivating “Systemness” to Create Personalized, High-Reliability Health Care

Becoming a high-reliability health system that is personalized, efficient, and effective means making some tough choices.

Shapiro01_pullquote - Using Simulations to Improve Physician Leadership Hiring

Using Simulations to Improve Physician Leadership Hiring

Department chairs are expected to motivate and inspire a diverse group of smart, ambitious, overworked physicians. But for most, it’s a challenge.

Standard Daily Management Visual Board at Baptist Health

Using Daily Management and Visual Boards to Improve Key Indicators and Staff Engagement

Baptist Health leverages Daily Management as a way to engage frontline staff and create a data-driven problem-solving culture to help the health system achieve its goals.

Connect

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

Learn More »

Topics

Leading Transformation

205 Articles

A Vision for Upending the Siloed…

A five-point plan unveils ways that leaders of health care and public health organizations can…

Moving from a Sickness Model of…

The expense of the U.S. health care system is so misaligned from what we need…

Physician Burnout

37 Articles

Applying Community Organizing Principles to Restore…

IHI offers four lessons on how to nurture joy in the health care workforce.

Insights Council

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

Apply Now