Seven-Step Pathway for Preventing Errors in Healthcare.

I N T R O D U C T I O NPreventable medical errors are the third-largest killer of Americans (heart disease and cancer are first and second, respectively); these errors result in about 400,000 deaths and cost $1 trillion annually in the United States (McCann, 2014). Medical errors first drew significant attention from the federal government, the public, and the private sector after the 1999 release of the Institute of Medicine's report To Err Is Human. Since then, numerous initiatives, guidelines, and strategies have been developed to solve this serious problem. However, considerable progress still needs to be made, and medicine lags far behind other industries. For instance, aviation has shown impressive results in error reduction, with an average of 10 critical incidents (errors) per 10 million processes (flights) since 1965 (World Health Organization [WHO], 2012). The automotive industry has also demonstrated substantial progress by using process improvement strategies such as Six Sigma and Lean principles (Asefeso, 2013; Sokovic, Pavletic, & Krulcic, 2006).Traditionally, the medical litigation system has been the main weapon in fighting preventable medical errors (Smullens, Evans, & Nash, 2005); however, this is a reactive approach rather than a proactive strategy. Meanwhile, medical liability is often at odds with patient safety because it creates a wall of silence among caregivers seeking to avoid litigation (Joint Commission, 2005). Hence, many researchers agree that the U.S. medical liability system is not effective in combating medical errors.The need for steps beyond medical litigation became clear in response to the report To Err Is Human. The federal government created the Agency for Healthcare Research and Quality (AHRQ, 2014) to investigate and reduce medical errors nationwide. Many healthcare providers have also adopted new strategies to reduce errors and their potential consequences. However, are all caregivers aware of the potentially grave consequences of medical errors? More important, are all caregivers equipped with proactive strategies to fight these errors? How practical and actionable are those strategies?In this essay, I describe common strategies for preventing medical errors, as well as the seven-step pathway for preventing errors in healthcare in response to these questions.C L A S S I F I C A T I O N OF MEDICAL ERRORSIdentifying and understanding the root causes of medical errors is not easy because of multiple variables in the healthcare domain. Several classifications are designed to categorize these errors based on a variety of factors, such as the causes, human behavior, level of human factor intervention, and type of medical intervention.According to Reason (1995), two types of medical errors exist: active and latent. Caregivers make active errors, which include cognitive errors (mistakes) and noncognitive errors (slips and lapses). Latent errors are caused by organizational design, such as incomplete procedures, inadequate training, and poor labeling (Reason, 1995). Moreover, the AHRQ Patient Safety Network (2015), a web-based resource, adds two more categories to active and latent errors: epidemiology of errors with adverse events and near-miss errors (i.e., events that did not result in injury, but had the potential to do so).Leape, Lawthers, Brennan, and Johnson (1993) grouped medical errors into four categories: diagnostic errors; treatment errors; preventive errors (e.g., failure to provide prophylactic treatment); and others, such as communication, equipment, or system failures. Moreover, cognitive psychology classifies human tasks into schematic behavior (i.e., tasks that are performed reflexively) and attentional behavior (i.e., tasks that require active planning and problem solving). Errors associated with schematic behavior are called slips and occur as a result of lapses of concentration, distractions, or fatigue. Errors associated with attentional behavior are called mistakes and often result from inexperience or insufficient training (AHRQ, 2014). …