By JAN CORBETT
It has become known as "medicine's dirty little secret."
In the United States, the Institute of Medicine has reported that nearly 100,000 Americans die each year from preventable errors in hospitals - more than the combined total of American deaths each year from car or plane crashes, suicides, falls, poisoning and drowning.
A further 1 million people are injured each year by medical mishaps.
Across the Atlantic, the latest British Medical Journal says most airlines make fewer mistakes handling baggage than hospitals make giving drugs to patients.
These surprising facts inspired President Bill Clinton to demand mandatory reporting of medical errors and the British Medical Journal to devote an entire issue to the problem.
Although no one knows how many New Zealanders are killed or maimed each year by preventable medical errors, this country has also joined the prevention movement. As the Herald revealed two weeks ago, the Health Funding Authority is beginning work on a protocol for mandatory reporting of such blunders.
Meanwhile, American researchers - leaders in the campaign to reduce medical errors - have been looking at why the aviation industry has a better safety record than medicine.
Their findings, which dominate the latest British Medical Journal, go beyond the obvious observations that when pilots blunder their own lives are at risk, they usually don't have the opportunity to wonder if they should tell someone they crashed the plane, and they cannot band together to testify that a 747 did not in fact fall out of the sky.
What's more, the airline industry knows people nervous about a poor safety record can take the bus.
The US researchers accept that an operating theatre is more complex than a cockpit and that aeroplanes behave more predictably than patients.
But they are still certain that medicine can learn a lot about safety from the airline industry.
After studying 1033 hospital doctors and nurses in American and European hospitals and 30,000 cockpit crew from major international airlines, University of Texas academics Professor Robert Helmreich and doctoral student Bryan Sexton discovered significant cultural differences between medics and aviators.
They found consultant surgeons were three times more likely than pilots to deny that stress or fatigue affected them. Anaesthetists were twice as likely to deny it.
Most pilots opposed the idea of rigid hierarchies where juniors could not make suggestions to or question their superiors. Only half the surgeons thought such hierarchies were a bad idea.
Only a third of medical staff said their hospitals handled errors well, and a third of intensive care staff denied ever making errors. Half said they had difficulty discussing mistakes.
The authors conclude that "much progress has been made to create a culture in aviation that deals effectively with error, whereas in medicine substantial pressures still exist to cover up mistakes, thereby overlooking opportunities for improvement."
Explaining the different culture in aviation, the authors say that since the introduction of jet transport in the 1950s, the industry had recognised that accidents were caused by breakdowns in crew coordination, communication and decision-making.
As a result, it made a gradual but steady shift towards "a more open culture that accommodated questioning and recognised human limitations."
Airlines changed the way they selected and trained pilots, looking for people who could coordinate activities, learn from their mistakes and accept advice from others.
And they concentrated on training entire crews together, rather than training individuals.
But perhaps the key difference between pilots and medics is that pilots are not punished or shamed when they admit to mistakes. Instead, error reporting is used to learn how to avoid mistakes or reduce their effect next time.
By contrast, doctors are shackled with a blame-and-shame culture.
Writes James Reinertsen, chief executive of a Boston medical centre: "We don't talk about errors because, deep down, we believe individual diligence should prevent errors, so the very existence of error damages our professional self-image."
Albert Wu, associate medical professor at Johns Hopkins University in Baltimore, describes how doctors become the second victim of their errors: "Virtually every practitioner knows the sickening realisation of making a bad mistake ... You agonise about what to do, whether to tell anyone, what to say ... You know you should confess, but you dread the prospect of potential punishment and of the patient's anger."
The British Medical Journal's guest editors, Harvard Professor Lucian Leape and the chief executive of the Institute for Healthcare Improvement Donald Berwick, say a culture that discourages facing up to errors is one of the chief impediments to improving patient safety.
So are traditional ways of working.
They write: "Health care alone refuses to accept what other hazardous industries recognised long ago - safe performance cannot be expected from workers who are sleep-deprived, work double or triple shifts, or whose job designs involve multiple competing urgent priorities."
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