You authored the world's bestselling primer Understanding Patient Safety.
What's the single most important component of keeping patients safe?
Medical errors don't happen because doctors or nurses are bad or careless. They
occur because systems are dysfunctional, overly complex and don't anticipate that
humans will blow it from time to time. Organizations that have made themselves
safe have strategies to get frontline providers to understand safety science
and "goof-proof" operating rooms and surgical procedures. That requires
hard work. It's not something we learned in medical or nursing school.
How has patient safety evolved in recent years?
We've gone from a paper system to a digital system. The impact of that
on patient safety has been mostly positive. But computers create
their own kinds of mischief. New kinds of errors occur stem from
physicians and nurses spending so much time looking at screens
instead of patients, they're no longer talking to their colleagues in
ways they used to or they turn their brain off and don't notice that the
computer is doing something wrong.
How has COVID-19 altered the fundamental approach to patient care?
The pandemic created a need to be much nimbler. Organizational changes
that normally would have taken a year of meetings and debates were made
in a week because of the outbreak. That's been healthy for organizations
that typically take too long to make decisions. That said, the biggest trans-
formation that COVID will leave behind is telemedicine. At UCSF, use of
telemedicine for appointments went from 1% to 70% in months. To me,
that's for the good. The healthcare system's adoption curve would have
lasted 10 years if left on its own. Instead, it basically took three months.
What is the biggest challenge in protecting patients from harm?
There are so many competing imperatives compared with when the patient
safety field began 20 years ago following the release of the Institute of
Medicine's To Err Is Human. Back then, organizations focused the bulk of
their efforts, resources and initiatives on patient safety. A few years later,
the quality movement began. Then, as cost pressures rose, the value move-
ment started. Now, we're also focusing on improving patient satisfaction
and decreasing physician burnout. And we're also attacking healthcare dis-
parities and improving health equity. These are all really good, really
important things, but they are competing against each other. Because of
that, there's no question that safety is getting less attention now than it did
15 years ago when it was the only kid on the block.
OSM
Dr. Wachter (robert.wachter@ucsf.edu) is a professor and chair of the department of
medicine at the University of California, San Francisco.
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Q & A
'Goof-Proof' ORs Need Time, Care & Resources
Q&A with Robert Wachter, MD, the
physician who literally wrote the book on patient safety.
