Dr. Louis Constan

Over the last two decades our medical leaders have been flummoxed (and embarrassed) over how to explain why the United States, which spends twice as much as other advanced nations on health care, has a persistently lower life expectancy. We have the best doctors, hospitals, pharmaceutical companies, and biotechnology in the world; what could possibly explain this discrepancy?

One explanation, never satisfying to me, has been to blame the victims.  American patients are sicker and die sooner, in spite of everything we doctors do; simply because they do not take care of themselves.  They eat too much, smoke too much, and don’t exercise.  It’s their fault.  We doctors are doing everything we can.  Or perhaps it’s because we don’t spend as much as other advanced countries on social services, as such spending has been shown to improve health outcomes. 

The truth is that there are several factors and one big one is how our healthcare system handles errors. There is now clear evidence that some of the fault, much as we dread to hear it, lies with ourselves, or at least with our healthcare delivery system. That 2016 mega study from Johns Hopkins showed good evidence that 250,000 patients die annually in American hospitals from various errors in their care. Of the 2.4 million Americans who die each year, easily 10 percent die of non-natural causes while they are hospitalized, from errors somewhere in the course of their care. That 10 percent is even worse considering that many of those total 2.4 million deaths were older patients who died because, in some sense, their ‘time had come.’  For those 250,000, though, many were younger and clearly died ‘before their time.’ Years-of-life-lost were not calculated in this study, fortunately for us.

Doubtless you’ve struggled to wrap your head around the enormity of this number and the insidiousness of a problem that has simmered beneath the surface for so long.  But when you think about the complexity of what goes on in American hospitals, it’s really not so hard to understand.  36 million admissions, 145 million ER visits, 129 million surgeries.  Every one of those situations involves multiple physicians, dozens of ancillary staff, multiple medicines, tests, critically timed decisions, and easily misunderstood person-to-person hand-offs.  You might be tempted to accept the tiny, tiny percentage of fatal errors as inevitable and acceptable but it is certain that your patients don’t.

250,000 deaths, the third leading cause of death in Americans of all ages, is simply too, too high a number and, if we are going to continue to have the trust of our patients, we are going to have to act.  

The model for a solution exists… in the airline industry.  

Millions of miles flown, but the airline industry does not accept the occasional error, the occasional crash and death of their customers. They aim for zero deaths, and they do it by ruthlessly rooting out any and all errors. And have they succeeded? Absolutely they have.  

And we can too.

With THRIVE’s ZERO HARM INITIATIVE, which on May 26, in front of 650 witnesses, 12 top executives from our regional healthcare organizations solemnly swore to uphold. These are the powerful leaders who engage actual fiscal responsibility in our hospitals. They hire and fire staff. They set up training programs. They buy computer programs and upgrades. They reward employees who come forward with issues, small and large, before those issues lead to critical errors. They reward staff financially for ideas to fix those problems.  

In summary, one clear failure of the American healthcare system is its insufficient attention and progress in addressing errors.  Doing so would clearly improve the overall health and longevity of the American public. Perhaps it has never been realistic to look solely to doctors as the sole protectors of America’s health. Too many patients are being impacted by factors beyond the control of we physicians alone and we need a total systems solution here. We can give our all to patient care.  Our best efforts, the most up-to-date treatment; the most skilled resuscitation; the most brilliant surgical technique; the most inspired diagnosis; literally pulling our patient from the jaws of death just may not be recognized because these successes are eclipsed by all the deaths caused by medical error. Perhaps every life we save is negated by a life lost to medical error? Such a terrible thought, but it would explain a lot!  

Looking forward, though, we should be proud of our hospitals, and their administrators, have taken this step. The thought that, in the future, in our hospitals, no patients will die from avoidable causes is simply an incredibly awesome goal. It is good for all of us. For the hospitals, for we doctors, and especially for the patients!

Dr. Louis Constan