The safety of patients is a lower priority for most hospitals than balancing the books and hitting performance targets, England's chief medical officer, Liam Donaldson, told a European Union summit on patient safety this week.
This was despite the fact that adverse events occurred in one in 10 hospitalisations and that people had a far higher risk of being killed by medical error than of dying in an air crash.
“When a chief executive puts their head on the pillow at night they will be worrying about two things: the financial position of the organisation and its performance targets,” Professor Donaldson told the conference, which was held as part of the UK's presidency of the EU. “They are not worrying yet about the safety of their organisation.”
Health organisations needed to hold a mirror up to themselves and ask what their record was on patient safety, he said.
Organisations' attitude to patients' safety could be assessed in several ways, said Professor Donaldson. “If something serious happens, would the instinct be to cover up or to learn so that the risks could be reduced? Are patients and their experience truly embedded within the organisation? And can we demonstrate that we're getting safer each year?”
It was a paradox that people were more frightened of air travel than health care, he said. “The risk of being killed in a plane crash is one in 10 million, while the risk of being killed in a developing country through medical error is something like one in 300.”
The aviation industry had transformed its safety record by acknowledging that human error was inevitable and then setting out to minimise the consequences by strengthening systems, creating an open, blame free climate, and encouraging committed leadership.
It was also vital that patients had the information and power to challenge health professionals. “If they have any concerns they should not sit silently but ask questions and challenge,” said Professor Donaldson.
Although the main victim of a medical tragedy was the family, the secondary victims were staff, the conference heard. Margaret Murphy, whose son died after a series of medical mistakes, described how she met one of the junior doctors in a lift shortly afterwards.
“He said, ‘I didn’t think he'd die,' and then just fled the scene. Obviously no one had taken care of him afterwards. I often think of him and wonder how he's faring,” she said.
Several speakers stressed that the current figures for adverse events were probably underestimates. Lucian Leape, adjunct professor of health policy at Harvard School of Public Health, who led the first major study of patient safety in the United States 20 years ago, said he often challenged surgeons to review their last 10 deaths. “I guarantee you that if you [do this] you'll find at least one where in retrospect you will find errors that might have led to a different outcome.”
The health secretary, Patricia Hewitt, announced at the conference that the UK is to provide £25m ($43m; €37m) over the next five years to the World Health Organization's World Alliance for Patient Safety, a body launched last year to raise awareness around the world of safety issues.