Patient safety needs openness, not point-scoring

Civitas, 15 January 2009

Trawling over the health press I’d missed in a week’s holiday yesterday, this headline has got to be the winner: ‘Deaths from hospital blunders soar 60% in two years as NHS staff ‘abandon quality of care to chase targets’ says the Daily Mail. Really?

I’m a huge critic of the use of targets in any public sector organisation, particularly one as complex as health care and, unquestionably, they have distorted and interfered with clinicians’ ability to deliver the optimum care. Targets may, as previous reports by the Healthcare Commission into tragedies such as Maidstone & Tunbridge Wells show, have also killed by distracting organisations from the importance of patient safety and the first maxim of medicine: do no harm.
However, to claim that deaths from hospital blunders have soared 60 per cent due to targets is fallacious, on two fronts. First, there is no statistical evidence provided that links the ‘blunders’ to targets; it is shameless political point-scoring (again, I’m not saying there are not instances where targets have led to blunders, but there is certainly no evidence targets have caused them to increase by 60 per cent over the past two years).
But more foolhardy is the base statistic: the claim that hospital blunders themselves have risen by 60 per cent in the past two years. If they had, it would be truly shocking. But the statistic is actually based on the reporting of incidents to the NPSA; which, as the article later acknowledges, is in its infancy. The 60 per cent increase is probably almost solely down to trusts reporting adverse incidents to it for the first time.
Such public reporting is part of a vital change in cultural attitudes to patient safety, promoting openness and transparency. Only by such reporting can we start to learn why adverse incidents happen, which is often a very complex matter. As numerous studies have shown, the source of most errors is not individual malpractice, but the systems or the context in which mistakes occur.
No-one is denying that too many mistakes are made, both in the NHS and in health systems more generally. The fact that between 8.7 and 10 per cent of stays in NHS hospitals typically involve mistakes (according to a comprehensive study of medical records by an expert) is tragic. As is the fact that rates are similar elsewhere. But punitive attitudes to medical errors or other unsatisfactory aspects of care assume that complaints, threats and menaces are the only way to ensure improvement. This is a trend worth opposing. As the intelligent controlled trial by Atul Gawande and his colleagues at the WHO shows only too clearly, an open approach based on clinical engagement and learning is far more effective. Through his work we now have a tried and tested checklist that can really have an impact on patient safety.
Politicians and journalists should be wary of the impact of what they preach.