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Do you have experience in healthcare? 3% isn't shocking to me, in fact a number of studies of IV med administration have error rates narrowly on either side of

Do you have experience in healthcare? 3% isn't shocking to me, in fact a number of studies of IV med administration have error rates narrowly on either side of 50% and serious error rates in the double digits. This report suggests that you're safer in surgery than elsewhere in the hospital :| I spent over a decade working on technology solutions to prevent medication errors in hospitals but the bottom line problems that make it a hard problem to solve are: 1. There is a culture of individual blame and so (certainly most) errors go un-reported at all. Systematic identification and process solution is still not healthy, despite 16 years having passed since IOM did an admirable job shining light on the problem [1] 2. There isn't strong enough motivation to fix. It's easier to not report medication errors than to fix them. You or someone you know has probably been victim of a medication given in error one way or another. You just aren't likely aware of it. Many errors aren't very serious, or result in lengthened hospital stays (which guess what!? the responsible institution probably gets paid for). Even the consequences of serious errors aren't often (maybe even usually) attributed to the source mistake. Like many things, money has driven the status quo (more money in ignoring than acknowledging) and it'll drive the solution. Accountability and solutions to this problem will come in the form of payers [your insurance company] finding ways to measure and not reimburse for consequences of errors. Once that motivation exists in a major way solutions will show up very quickly... it's a non-trivial, but also sub-ridiculously-hard problem to solve, from a process/technical perspective. [Edit: I've been out of this problem space for 6-7 years now (because fuck selling things to hospitals [2]) so would love to hear from anyone who knows whether things have changed significantly and my take is now wrong/dated.] [1] https://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf https://iom.nationalacademies.org/~/media/Files/Report%20Fil... [2] Not that it isn't super profitable - particularly if you spend way more on steak-dinner-sales than making shit that actually solves problems! An ironically terrible/frustrating market for anyone who actually cares about clinicians or patients, though.

vpribish 11y ago
My background is hedge fund and consumer website management - not healthcare. My ignorance aside* - your points, and solution seem right on. It's surprising that in these lightly-regulated, profit-driven, fields we seem to have set up effective processes for error reduction that are not standard in medicine! In trading operations we made (successful) efforts to avoid individual blame, track mistakes, record lessons learned, and continuously develop the processes and systems -- all motivated by the client's money at the end of the day though it was professional culture that was at work minute-by-minute. * if only...
- famousactress 11y ago
  Is trading lightly regulated? Terrifying :) Even then I assume it's not hard to arrive at a hard-dollar-ROI story that drove the improvements. Medication errors end up being a bit of a staring contest: Obviously there's the potential for value in terms of outcomes that are costing someone (payer) money.. but I think historically it's been a hard-enough problem to solve and a hard-enough problem for payers (or anyone, really) to see. Kind of a natural deadlock. The problem has gotten some attention, though. The IMO study lit a fire, and companies like the ones I worked for chased it down with an obviously vested interest in shining a light on the problem. Bottom line is that hospitals (maybe even most of them now?) buy shit to make this not happen anymore. I wonder if the fashion around buying those things has waned though. I don't really hear about buzz/movement in this space the way I used to, and I severely doubt it's a Solved Problem yet. Remaining (and super fundamental) problem is that it's way easier and cheaper to sell hospitals garbage than it is to build great solutions (and even if you build great solutions, it doesn't make them massively easier to sell to hospitals). So until there's some external measurement and accountability, the entire problem space will be dominated by perception-management and not actually moving needles that matter enough.
lloyd-christmas 11y ago
Working in medtech in the implant space, my recent revelation is that choosing the incorrect implant only 10% of the time is a good error rate. Many hospitals are closer to 25%. The only motivation to fix it is that they want to make sure they put cheaper implants into people expected to die sooner.
JonnieCache 11y ago
There's a great documentary comparing the safety cultures of healthcare (individual blame) vs airlines (blame-free.) Listen here: http://www.bbc.co.uk/programmes/p02x3vwh http://www.bbc.co.uk/programmes/p02x3vwh
anon4 11y ago
I would be interested in seeing the error rates from countries with nationalised healthcare.
- famousactress 11y ago
  Yeah. If your hypothesis is that it might be lower when the payer and provider are effectively the same entity you could also look closely at the VA or Kaiser in the US for comparison. Both have historically had reputations in the past for doing better-than-average with regard to patient safety but I'm not sure whether there are apples-to-apples numbers that bear that out. In one sense you'd think having responsibility for both sides of the equation would drive quality up by attaching responsibility for care with responsibility for cost... but in another sense it the lack of tension from going from two-actors to one can make things worse. To fix a problem like this you've got to surface it first, and surfacing it leads to lots of legal exposure while you figure out how to fix it. See the VA scandal of the past year or two for instance. It seems unlikely those kinds of lapses in care would have been as prevalent if an outside party was taking on risk and picking up the bill for services rendered (or the consequences of not rendering them, in this case)... That's just me speculating though.

vpribish 11y ago

My background is hedge fund and consumer website management - not healthcare. My ignorance aside* - your points, and solution seem right on. It's surprising that in these lightly-regulated, profit-driven, fields we seem to have set up effective processes for error reduction that are not standard in medicine! In trading operations we made (successful) efforts to avoid individual blame, track mistakes, record lessons learned, and continuously develop the processes and systems -- all motivated by the client's money at the end of the day though it was professional culture that was at work minute-by-minute. * if only...

famousactress 11y ago
Is trading lightly regulated? Terrifying :) Even then I assume it's not hard to arrive at a hard-dollar-ROI story that drove the improvements. Medication errors end up being a bit of a staring contest: Obviously there's the potential for value in terms of outcomes that are costing someone (payer) money.. but I think historically it's been a hard-enough problem to solve and a hard-enough problem for payers (or anyone, really) to see. Kind of a natural deadlock. The problem has gotten some attention, though. The IMO study lit a fire, and companies like the ones I worked for chased it down with an obviously vested interest in shining a light on the problem. Bottom line is that hospitals (maybe even most of them now?) buy shit to make this not happen anymore. I wonder if the fashion around buying those things has waned though. I don't really hear about buzz/movement in this space the way I used to, and I severely doubt it's a Solved Problem yet. Remaining (and super fundamental) problem is that it's way easier and cheaper to sell hospitals garbage than it is to build great solutions (and even if you build great solutions, it doesn't make them massively easier to sell to hospitals). So until there's some external measurement and accountability, the entire problem space will be dominated by perception-management and not actually moving needles that matter enough.

lloyd-christmas 11y ago

Working in medtech in the implant space, my recent revelation is that choosing the incorrect implant only 10% of the time is a good error rate. Many hospitals are closer to 25%. The only motivation to fix it is that they want to make sure they put cheaper implants into people expected to die sooner.

JonnieCache 11y ago

There's a great documentary comparing the safety cultures of healthcare (individual blame) vs airlines (blame-free.) Listen here: http://www.bbc.co.uk/programmes/p02x3vwh http://www.bbc.co.uk/programmes/p02x3vwh

anon4 11y ago

I would be interested in seeing the error rates from countries with nationalised healthcare.

famousactress 11y ago
Yeah. If your hypothesis is that it might be lower when the payer and provider are effectively the same entity you could also look closely at the VA or Kaiser in the US for comparison. Both have historically had reputations in the past for doing better-than-average with regard to patient safety but I'm not sure whether there are apples-to-apples numbers that bear that out. In one sense you'd think having responsibility for both sides of the equation would drive quality up by attaching responsibility for care with responsibility for cost... but in another sense it the lack of tension from going from two-actors to one can make things worse. To fix a problem like this you've got to surface it first, and surfacing it leads to lots of legal exposure while you figure out how to fix it. See the VA scandal of the past year or two for instance. It seems unlikely those kinds of lapses in care would have been as prevalent if an outside party was taking on risk and picking up the bill for services rendered (or the consequences of not rendering them, in this case)... That's just me speculating though.