Today our topic of discussion is Harm in Healthcare.
Harm in Healthcare
Safety in other domains is assessed by the incidence of accidents and injuries; aviation accidents, road accidents, lost time injuries at work and other types of mishap are H counted and tabulated by various means.
In healthcare we would like to have a general index of safety, rather like rates 7 of road or rail accidents, so that we could track progress over time and ask more sophisticated questions about the safety of different parts of the system and the factors that increased or degraded safety.
Defining harm, however is a particularly difficult issue in healthcare for a number of reasons:
- In other arenas establishing cause and effect between accident and injury is reasonably straightforward. In contrast, patients are generally, though not always, sick and separating the harm due to healthcare from that due to illness is often difficult
- Some treatments given in healthcare are necessarily ‘harmful’ to the patient; radiotherapy and chemotherapy are two obvious examples
- Harm from healthcare may not immediately be detected or may only gradually become apparent. In fact, a cause celebre of medical error-the chemotherapy overdose of Boston Globe reporter Betsy Lehman-was only discovered on a routine review of research data.
- Even if a patient is harmed this does not necessarily point to any deficiencies in care. One patient may get pneumonia because of a major lapse in basic care; another may receive exemplary care but still succumb to pneumonia (Figs. 6.2 and 6.3).
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