his is the final report of a two-year Hastings Center researchproject that was launched in responseto the landmark 1999 report from theInstitute of Medicine,
To Err Is Human
, and the extraordinary atten-tion that policymakers at the federal,state, regulatory, and institutional lev-els are devoting to patient safety. Itseeks to foster clearer and better dis-cussion of the ethical concerns thatare integral to the development andimplementation of sound and effec-tive policies to address the problem of medical error. It is intended for poli-cymakers, patient safety advocates,health care administrators, clinicians,lawyers, ethicists, educators, and oth-ers involved in designing and main-taining safety policies and practices within health care institutions. Among the topics discussed in thereport:
the values, principles, and per-ceived obligations underlying pa-tient safety efforts;
the historical and continuingtensions between “individual” and“system” accountability, betweenerror “reporting” to oversight agen-cies and error “disclosure” to pa-tients and families, and betweenaggregate safety improvement andthe rights and welfare of individualpatients;
the practical implications forpatient safety of defining “respon-sibility” retrospectively, as praise orblame for past events, or prospec-tively, as it relates to professionalobligations and goals for the fu-ture;
the shortcomings of tort liabili-ty as a means of building institu-tional cultures of safety, learningfrom error, supporting truth tellingas a professional obligation, or ad-equately compensating patientsand families, contrasted with alter-native models of dispute resolu-tion, including mediation and no-fault liability;
the needs of patients, families,and clinicians affected by harmfulerrors and how these needs may beaddressed within systems ap-proaches to patient safety; and
the potential conflicts betweenthe protection of patient privacy required by the Health InsurancePortability and Accountability Actand efforts to use patient data forthe purposes of safety improve-ment, and how these conflicts may be resolved.
Although this report is the work of the project’s principal investigator,not a statement of consensus, it drawsfrom the insights of the interdiscipli-nary group of experts convened by The Hastings Center to make sense of the complex phenomenon of patientsafety reform. Working group mem-bers brought their experience as peo-ple who had suffered from devastat-ing medical harms and as institution-al leaders galvanized to reform by tragic events in their own health careinstitutions. They brought expertiseas clinicians, chaplains, and risk man-agers working to deliver health care,confront its problems, and make itsafer for patients. They brought fa-miliarity with the systems thinkingdeployed in air traffic control and inthe military. And they brought criticalinsight from medical history and soci-ology, economics, health care pur-chasing, health policy, law, philoso-phy, and religious studies.The research project was madepossible through a major grant fromthe Patrick and Catherine WeldonDonaghue Medical Research Founda-tion.
July-August 2003 / HASTINGSCENTERREPORT
AN OVERVIEW OF THE PROJECT
On the cover:
, by Frank Moore,1992. Oil on wood with frame and attach-ments. 49” x 58” overall. Private Collection,Italy. Courtesy Sperone Westwater, New York.