Departing Health and Disability Commissioner Ron Paterson is frustrated that hospitals and health workers continue to repeat the errors of others.
Mr Paterson steps down on Wednesday after a decade as New Zealand's top health watchdog.
He told the Weekend Herald his office began issuing reports that grouped similar issues
together because the same things turned up in complaints, such as short-staffing in emergency departments and referrals being lost between health boards.
"Time and time again we see the same thing. Just last month, I met with a group of about 40 clinicians working on preventing VTE [blood clots]. You see good people in all DHBs struggling on their own to try to prevent clots that can kill patients.
"It's an area that's now the number one patient safety goal in England. It's the sort of area where we still need to do a better job at co-ordinating and sustaining our national efforts."
Mr Paterson, who is returning to his career as a law academic and will become a professor at Auckland University, said, "We have a very good health and disability system, but it will never be acceptable that some people are harmed by the system and that's why we continue to need to learn the lessons from complaints."
