Empty hospital bed.

The Inevitability of Error in Health Care

By John Tingle

A recent publication by the World Health Organization (WHO), a first draft of a global patient safety action plan 2021-2030, seems to have rekindled conversations about the “inevitability of error” in the field of patient safety.

The “inevitability of error” argument indicates that mistakes in health care do inevitably happen; that they are the consequences of the complex nature of health care treatment. Nursing and medicine depend on people, and nobody is infallible — we all make mistakes.

WHO Draft Global Patient Safety Action Plan 2021-2030

The WHO report discusses the emergence of patient safety thinking in the introductory section of the report. The report states that in the period immediately after the Second World War, “the idea of safety was limited to traditional hazards such as fire, equipment failure, patient falls, and the risks of infection.” The report adds, “There was also a belief that well-trained staff-doctors and nurses-would always behave carefully and conscientiously and seek to avoid or minimize what were inevitable ‘complications’ of care.”

The report goes on to state that historically unexpected complications have long occurred in health care:

“For most of the 20th century, whilst such occurrences would occasionally hit the headlines, cause momentary public concern, and be a preoccupation of medical litigation attorneys, they aroused little interest amongst doctors and health care leaders. Why? Essentially, they were seen as the inevitable cost of doing business in the pressurized, fast-moving environment of modern health care that was saving lives and successfully treating many more diseases. Mistakes happen, it was argued.”

In recent times, there has been a paradigm shift in thinking about safety in health care: “the need to see human error as something to be mitigated and prevented rather than eliminated entirely.”

WHO framework for action includes seven strategic objectives including:

“(1) Make zero avoidable harm to patients a state of mind and a rule of engagement in the planning and delivery of health care everywhere.”

To make zero avoidable harm a mind-set is an excellent way of rationalizing the inevitability of harm argument.

We can never totally obliterate error

This point is also recognized in the National Health Service’s (NHS) patient safety strategy:

“It is human to make mistakes so we – the NHS – need to continuously reduce the potential for error by learning and acting when things go wrong.”

Like the WHO global patient safety action draft plan, the NHS patient safety strategy also holds important potential to help develop an ingrained patient safety culture in the NHS in England.

In thinking about patient safety and reflecting on the history of patient safety, it is important to recognize that we cannot totally obliterate error in health care. Not to recognize this would lead to the setting of irrational and poor care objectives. We can have total elimination in our sights as a goal, but in real, practical terms errors can happen despite all our very best efforts. The best we can do is to strive to manage the risk of harm properly.

John Tingle

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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