The Paradox: Miracles and Vulnerabilities

Health care in 1998 stands where the nuclear power industry stood in 1979, following the Three Mile Island accident. It is a time of great contrasts. On one hand, it is a time when splendid new knowledge, more finely honed skills, and amazing technical advances bring sophisticated treatments to more people than ever before. On the other, there are widely reported "horror stories" of shocking injuries -- chemotherapy overdoses, wrong limb surgeries, catastrophic missed diagnoses -- and growing consumer demand to increase patient safety. There also is public concern that the organizational changes and financial pressures in health care are creating conflicting goals and incentives, which may compromise the safety of patients.

The new technologies pushing the frontiers of medicine are naturally used to treat ever sicker and more vulnerable patient populations. They help most, but also increase the statistical possibilities for poor outcomes. In short, at the same time that medical "miracles" are increasingly possible, new opportunities for patient injury also are being created. There is disagreement and confusion about the sources of and appropriate responses to these inherent risks in the complex environment of health care. It is in this setting that discussions about patient safety are now taking place.

Three Mile Island was a watershed event that irrevocably changed the way that the public, industry and regulators looked at safety in a technologically complex environment. This change created both the possibility of and the need for new approaches to safety. Health care faces very similar challenges and opportunities today.

Leaders in the health care community are responding. The founding of the National Patient Safety Foundation (NPSF) in 1997 is, itself, an important response, as are recent initiatives or reports developed by the Veterans Health Administration (VHA), the Agency for Health Care Policy and Research (AHCPR), the President's Advisory Commission on Consumers Rights and Health Care Quality, the Joint Commission on Accreditation of Health Care Organizations (JCAHO), and the Executive Session on Medical Error and Patient Safety at the John F. Kennedy School at Harvard University.