Executive Summary

Introduction

In order to understand the experiences and opinions of American adults (age 18+) on patient safety issues in the heath care environment, the National Patient Safety Foundation at the AMA commissioned Louis Harris & Associates (LHA) to conduct telephone interviews with randomly selected households nationwide.

· LHA's data collection staff completed 1,513 interviews between July 30 and August 21, 1997. Margins of error for questions asked of all 1,513 respondents are plus or minus 2.58% at the 95% confidence level. The Final Report is available online in Adobe Acrobat format.

Safety in General

The health care environment is perceived by the general public as "moderately" safe.

• The health care environment was rated a 4.9 on a 1 to 7 scale, where 1 is Not Safe at All and 7 is Very Safe. Thirteen percent of adults rated the health care environment as a 7 (Very Safe).
• In comparison to other types of environments, respondents view the health care environment as much safer than nuclear power or food handling, but somewhat less safe than airline travel or the workplace environment.

When asked, "What comes to mind when you think about patient safety issues in the health care environment?" more than one-quarter (28%) did not mention anything.

• Eighteen percent mentioned exposure to infection; 13% cited the general level of care patients receive and 11% cited the qualifications of health care professionals.

When asked to consider whether patient safety in the health care environment over the past five years has gotten better, stayed the same, or gotten worse, there was no clear answer among the public.

• An equal percent of adults believe that it has improved (33%), stayed the same (33%), or gotten worse (31%).

Adults believe they are most likely to encounter a medical mistake at a nursing home.

• Adults are least likely to believe they will encounter a medical mistake at the doctor's office or at the pharmacy.

Safety Precautions

Of the behaviors respondents were asked to consider, the two reported as "most risky" were not carrying a medical ID when one has a medical condition (75% very risky) and smoking tobacco (65% very risky).

• On average, adults view each behavior (not testing home smoke detectors; leaving appliances plugged in while away for long periods; not carrying an ID for a medical condition; eating raw or rare beef; not wearing a seatbelt in an automobile; smoking tobacco) as at least somewhat risky.

Overall, at least seven out of every ten adults report being very or somewhat likely to take certain safety precautions when dealing with health care professionals.

• The precaution most adults are likely to take is to get a second opinion on a serious diagnosis. Four out of five adults (80%) are very likely to take this precaution.

Health Care Professionals

Overall, adults were satisfied with their most recent experience with a health care professional.

• More than four out of five adults (84%) report being very or somewhat satisfied.

With respect to the elements of their most recent experience with a health care professional, adults reported the following as most lacking:

• 18% reported that the health care professional did not spend enough time with them, and/or
• 17 % reported that the health care professional did not give them enough information about all possible treatments to make an informed decision about their care..

Patient Safety

About half of adults (52%) believe the current health care system does have adequate measures in place to prevent medical mistakes; however, forty-two percent disagree.

Ninety-five percent of adults believe that their personal doctor, and 92% of adults believe that they, themselves, have a positive effect on patient safety.

• The lowest percentage of adults (40%) reported that they believe federal and state governments have a positive effect on patient safety.

Adults prefer to receive information about the risks and benefits of medical treatments in a written (63%) or verbal (52%) format.

• Twenty percent of adults selected a combination of both written and verbal as their preferred format.

Awareness of Medical Mistakes

Prior to being asked a series of questions about "medical mistakes," respondents were told, "Some examples of medical mistakes are when a wrong dose of medicine is given; an operation is performed other than what was intended for the patient; or results of a medical test are lost or overlooked."

Adults most frequently cite carelessness or negligence on the part of health care professionals when asked, "What do you think is the main cause of medical mistakes?" (29%).

• The second most frequently cited reason is that health care professionals are overworked, hurried, and stressed (27%). This cause may have a large effect on perceived carelessness or negligence on the part of health care professionals.

More than four out of five adults (84%) have heard about a situation where a medical mistake was made.

• The most commonly cited ways of learning about a situation are through a friend or relative (42%) or via television (22%).

Experience with Medical Mistakes

More than two out of five adults (42%) have been involved, either personally or through a friend or relative, in a situation where a medical mistake was made.

Of those adults who have been involved in a situation:

• The majority (56%) have been involved in only one situation. More than two out of five (42%) of adults have been involved in more than one situation.
• Two out of five (40%) report that the most recent medical mistake was a misdiagnosis. Approximately one-quarter report that the medical mistake was either an error with medication (28%) or an error during a medical procedure (22%).
• Nearly one-half (48%) of all mistakes occurred within a hospital. Almost one-quarter (22%) occurred within a doctor's office. This response conflicts with the respondents' perception that they are most likely to encounter a medical mistake in a nursing home.
• Carelessness or negligence on the part of health care professionals (29%) is the factor most commonly cited as causing the medical mistake.
• In more than one-third (38%) of all situations where a medical mistake occurred, respondents reported that nothing was done.
• One-quarter (27%) believe the medical mistake could have been avoided if health care professionals were more conscientious and thorough.

One out of three adults (32%) indicated that the medical mistake had a permanent negative effect on the patient's health.

The precautions adults are most likely to take as a result of their experiences are to:

• Ask questions (28%),
• Research the hospital, physician, and/or treatment (20%), or
• Get a second opinion (18%).

Nearly one out of ten adults (9%) state that they do not/or would not take any precautions to ensure their safety.

Adults who have been involved in a medical mistake report different attitudes about health care:

• They are significantly less likely to rate the health care environment as very safe (9% reporting as compared to 16%)
• They are more likely to believe patient safety in the health care environment has gotten worse (40% reporting worse as compared to 25%)
• They feel less satisfied about their last encounter with a health care professional (48% reporting very satisfied as compared with 63%)
• They feel significantly more likely to encounter a mistake in a nursing home (38% reporting very likely as compared with 23%), hospital (20% reporting very likely as compared with 10%), or doctor's office (8% reporting very likely as compared with 5%)

Preventing Medical Mistakes

An overwhelming majority of adults (95%) would report a medical mistake if they encountered one today.

• One out of three adults (35%) would go to the site of the mistake (e.g. the hospital administrator) and 33% would go to their doctor to report a medical mistake

Adults believe that keeping health care professionals with bad track records from providing care would be the most effective solution to preventing injury from medical mistakes.

• Three out of four adults (75%) believe that this solution would be very effective.

Adults also believe that better training of health care professionals, patients selecting doctors more carefully, forming an independent organization where causes of medical mistakes would be examined, and providing patients with information on how to ensure their safety would be effective solutions.

• Adults have less confidence that lawsuits against those who make mistakes and/or stricter government regulation of the health care system would be effective (solutions cited as "very effective" by 29% and 27% of respondents, respectively).

When asked if they had other suggestions on how to prevent medical mistakes from causing injury to patients, the top suggestions cited by adults were to improve oversight of caregivers' qualifications (31%), and to increase the public's awareness of the issues (13%).

October, 1997

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