Patient Experience Must Move Beyond Bad Apples
Authors: Azita Hamedani, Basmah Safdar, Emily Aaronson, Thomas H. Lee
Journal: Annals of Internal Medicine (2016)

Ideas and Opinions20 December 2016Patient Experience Must Move Beyond Bad ApplesAzita Hamedani, MD, MPH, MBA, Basmah Safdar, MD, Emily Aaronson, MD, and Thomas H. Lee, MDAzita Hamedani, MD, MPH, MBAFrom University of Wisconsin Hospital & Clinics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Yale School of Medicine, New Haven, Connecticut; Massachusetts General Hospital, Harvard Medical School, Massachusetts General Physicians' Organization, and Brigham and Women's Hospital, Boston, Massachusetts; and Press Ganey, South Bend, Indiana.Search for more papers by this author, Basmah Safdar, MDFrom University of Wisconsin Hospital & Clinics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Yale School of Medicine, New Haven, Connecticut; Massachusetts General Hospital, Harvard Medical School, Massachusetts General Physicians' Organization, and Brigham and Women's Hospital, Boston, Massachusetts; and Press Ganey, South Bend, Indiana.Search for more papers by this author, Emily Aaronson, MDFrom University of Wisconsin Hospital & Clinics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Yale School of Medicine, New Haven, Connecticut; Massachusetts General Hospital, Harvard Medical School, Massachusetts General Physicians' Organization, and Brigham and Women's Hospital, Boston, Massachusetts; and Press Ganey, South Bend, Indiana.Search for more papers by this author, and Thomas H. Lee, MDFrom University of Wisconsin Hospital & Clinics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Yale School of Medicine, New Haven, Connecticut; Massachusetts General Hospital, Harvard Medical School, Massachusetts General Physicians' Organization, and Brigham and Women's Hospital, Boston, Massachusetts; and Press Ganey, South Bend, Indiana.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-1725 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Don Berwick revolutionized how health care approaches quality improvement in his 1989 article, “Continuous Improvement as an Ideal in Health Care” (1). He described how “The Theory of Bad Apples” was simply not getting the job done. Yes, there were outlier physicians who were negligent, but the more significant problem was systems that facilitated predictable errors (such as vials of the same color or size for benign and toxic medications) or did too little to avoid them (for example, handwritten prescriptions). Berwick noted that focusing on finding the “bad apples” created an environment of fear, blame, and shame that was ...References1. Berwick DM. Continuous improvement as an ideal in health care. N Engl J Med. 1989;320:53-6. [PMID: 2909878] CrossrefMedlineGoogle Scholar2. Bendesky BS, Hunter K, Kirchhoff MA, Jones CW. Same physician, different location, different patient satisfaction scores. Ann Emerg Med. 2016. [PMID: 26875063] doi:10.1016/j.annemergmed.2015.12.021 CrossrefMedlineGoogle Scholar3. Carayon P, Wetterneck TB, Rivera-Rodriguez AJ, Hundt AS, Hoonakker P, Holden R, et al. Human factors systems approach to healthcare quality and patient safety. Appl Ergon. 2014;45:14-25. [PMID: 23845724] doi:10.1016/j.apergo.2013.04.023 CrossrefMedlineGoogle Scholar4. Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J, et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015;90:1600-13. [PMID: 26653297] doi:10.1016/j.mayocp.2015.08.023 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Wisconsin Hospital & Clinics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Yale School of Medicine, New Haven, Connecticut; Massachusetts General Hospital, Harvard Medical School, Massachusetts General Physicians' Organization, and Brigham and Women's Hospital, Boston, Massachusetts; and Press Ganey, South Bend, Indiana.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1725.Corresponding Author: Thomas H. Lee, MD, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; e-mail, [email protected]org.Current Author Addresses: Dr. Hamedani: Department of Emergency Medicine, University of Wisconsin Hospital & Clinics, University of Wisconsin School of Medicine and Public Health, 800 University Bay Drive, Suite 310, Mail Code 9123, Madison, WI 53705.Dr. Safdar: Department of Emergency Medicine, Yale School of Medicine, 464 Congress Avenue, Suite 260, New Haven, CT 06519.Dr. Aaronson: Massachusetts General Hospital, Department of Emergency Medicine, Zero Emerson, Suite 3B, Boston, MA 02115.Dr. Lee: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.Author Contributions: Conception and design: A. Hamedani, B. Safdar, E. Aaronson, T.H. Lee.Analysis and interpretation of the data: A. Hamedani, B. Safdar, E. Aaronson.Drafting of the article: A. Hamedani, B. Safdar, E. Aaronson, T.H. Lee.Critical revision of the article for important intellectual content: A. Hamedani, B. Safdar, E. Aaronson.Final approval of the article: A. Hamedani, B. Safdar, E. Aaronson, T.H. Lee.Provision of study materials or patients: B. Safdar.Statistical expertise: B. Safdar.Obtaining of funding: B. Safdar.Administrative, technical, or logistic support: B. Safdar, E. Aaronson.Collection and assembly of data: B. Safdar.This article was published at www.annals.org on 18 October 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byClinical Quality and Patient Experience in the Adult Ambulatory SettingDevelopment of a framework to describe patient and family harm from disrespect and promote improvements in quality and safety: a scoping reviewThe opioid epidemic and patient satisfaction: a review of one institution’s experience 20 December 2016Volume 165, Issue 12Page: 869-870KeywordsDisclosureEmergency medicineHealth careHealth care providersHospital medicineMyocardial infarctionNursesPatient advocacyQuality improvementSafety ePublished: 18 October 2016 Issue Published: 20 December 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...