What is Driving Hospitals' Patient-Safety Efforts?

Kelly J. Devers; Hoangmai H. Pham; Gigi Liu


Health Affairs. 2004;23(2) 

In This Article

Abstract and Introduction

The Institute of Medicine's report To Err Is Human described the alarming prevalence of medical errors and recommended a range of activities to improve patient safety. Three general mechanisms for stimulating hospitals to reduce medical errors are professionalism, regulation, and market forces. Although some believe that market forces are becoming more important, we found that a quasi-regulatory organization (the Joint Commission on Accreditation of Healthcare Organizations) has been the primary driver of hospitals' patient-safety initiatives. Professional and market initiatives have also facilitated improvement, but hospitals report that these have had less impact to date.

The year 1999 was a watershed period for patient safety. With the publication of the Institute of Medicine's (IOM s) report To Err Is Human, medical error became a national problem that became increasingly difficult for providers to ignore.[1] The report set some ambitious goals for all parties in the health care system, calling for a 50 percent reduction in medical errors over five years. To achieve this goal, the report argued that a multifaceted approach was needed, and its recommendations reflected this view.

Three general mechanisms can stimulate hospitals to improve patient safety and quality more broadly: professionalism, regulation, and markets. Professionalism is a system of self-governance, wherein members of a profession set and maintain standards primarily through shared values, norms, and educational activities. Regulation is when the government establishes a set of standards to which all parties must adhere. U.S. health care regulation has been strongly influenced by professionals, in that the government often allows regulatory requirements to be satisfied by adherence to standards established by professional associations, or public and private organizations governed primarily by professionals. For example, hospitals participating in Medicare are required to undergo regulatory review by the Centers for Medicare and Medicaid Services (CMS). Alternatively, through its "deeming authority," the CMS allows hospitals to participate if they are accredited by a private body approved by the CMS (such as the Joint Commission on Accreditation of Healthcare Organizations, or JCAHO). Private organizations fulfilling this role are sometimes referred to as quasi-regulatory organizations. Finally, purchasers and consumers can use market mechanisms to stimulate hospitals to improve patient safety by rewarding or punishing them based on their patient-safety performance or progress.

The purpose of this paper is to describe hospitals' systems and freestanding hospitals' patient-safety initiatives; their progress toward implementing them; and the relative roles that professionalism, regulation, and markets play in stimulating progress.[2] The paper addresses three specific questions: (1) What are hospitals' major patient-safety initiatives now, and how far along are hospitals in implementing them? (2) What facilitates and impedes hospitals' progress in patient safety in local markets? (3) What impact have patient-safety efforts had on hospitals, the health care professionals working with them, and patients?