Since the release of To Err Is Human, dozens of surveys of the landscape of American health care have been conducted, with sometimes surprising - and frightening - results. One survey, conducted by the Kaiser Family Foundation, the Agency for Healthcare Research and Quality, and the Harvard School of Public Health and published in November 2004,2 reviewed the status of the average American's perceptions about the quality of health care, along with their experiences with their health care providers and the quality of health-related information they receive. The survey shows that despite the efforts of hospitals, doctors, health plans and insurance companies to reduce medical errors and improve the quality of care, more than half of all American adults are dissatisfied with the current quality of health care provided in the U.S. In addition, a significant percentage believe that the quality of health care in the United States has actually gotten worse, not better, in the 5 years since To Err Is Human was published.
The survey was performed between July 2004 and September 2004, and conducted by telephone to a random sample of 2,012 adults across the United States. The respondents were asked a series of questions about their perception of the quality of health care; their awareness (and use) of quality information in making choices about health care; and previous experiences with health care providers. They were also read a common definition of "medical errors," and asked about their knowledge of (and any personal experience with) medical errors.
In terms of consumers' overall perceptions about their medical care, an analysis of the responses showed downward trends in satisfaction and quality of care. According to the survey:
- Over half (55%) of the public stated that they are currently dissatisfied with the quality of health care in this country, compared to 44% who reported the same in 2000. Conversely, about four in ten (41%) reported that they are satisfied with the quality of health care in this country, compared to 54% in 2000.
- Four in ten (40%) say the quality of health care has "gotten worse" in the past five years, compared to 17% who say it has "gotten better" and 38% who say it has "stayed about the same."
- Nearly half (48%) of the adults surveyed say they are at least somewhat worried about the health care that they and their family receive, including 22% who say they are "very worried."
With more than half of the public dissatisfied with the quality of their health care and 40% believing that it has "gotten worse," it is no wonder why almost half of all adults are at least somewhat worried about their health care. It is clear that the confidence barometer is falling.
Personal Experience With Medical Errors
More and more people (43%) have become familiar with the term "medical errors." The number of people familiar with the term is not that far ahead of those who have been involved in medical errors through personal experience, or that of a loved one. In fact, according to the survey, having knowledge of, or personally experiencing, a medical error has almost become a fact of life as far as medical care is concerned:
- Thirty-four percent of the public say that they have been involved in a situation where a preventable medical error was made in their care or the care of a family member. This includes 21% who say that the medical error they were involved with most recently had serious health consequences, including severe pain (16%); serious loss of time at work, school, or other important life activities (16%); temporary disability (12%); long-term disability (11%); and/or death (8%).
- Among those who say they or a family member has experienced a medical error, nearly three in four (72%) say the doctor involved has "a lot of responsibility" for the error.
- Among those who say they or a family member has experienced a medical error, 11% (or four percent of the total public) report they or their family member sued a health care professional for malpractice after experiencing the medical error.
- Of those who say the medical error they or their family member experienced had serious health consequences, 14% (or three percent of the total public) report they or their family member sued a health care professional for malpractice after experiencing the medical error.
- Several issues were indicated as being "very important" causes of medical errors. Seventy-four percent of those surveyed said that "overwork, stress or fatigue of health professionals" could cause a serious medical error, followed by doctors not having enough time with patients (70%), too few nurses (69%), health providers "not working together or not communicating as a team (68%), poor training (58%), the influence of HMOs and other managed care plans on treatment decisions (55%), and poor handwriting by health care providers (52%).
Although the survey didn't investigate this area, the above results may explain why malpractice insurance rates for medical doctors are considerably higher than they are for doctors of chiropractic.
Reporting of Medical Errors
Reporting medical errors is another trust issue. The results of the Kaiser/AHRQ/Harvard survey suggest that the barometer of trust between patients and practitioners may be unacceptably low in this area as well:
- Among those who say they or a family member have experienced a medical error, seven in ten (70%) say that the doctor or health professional involved did not tell them that a mistake had been made.
- Just over half (54%) of all people believe their doctor would be "very" (23%) or "somewhat "(31%) likely to tell them if a preventable medical error that resulted in serious harm was made in their care. Another one in four (25%) say that it is "not likely" that their physician would tell them, and 19% say that it is "not at all likely."
Based on these results, 44% of the American public does not expect their medical doctor to inform them of a medical error if one occurs. Even more alarming, the survey suggests that for those people who were involved in a medical error, 70% weren't informed of it by their doctor or health care provider.
A clear majority of respondents suggested that reporting serious medical errors would help improve the quality of health care. According to the survey:
- Ninety-two percent of U.S. adults believe that reporting of serious medical errors should be required. Assuming that medical errors are reported, 63% said that hospital reports of serious medical errors should be made public.
- Sixty-three percent feel that physicians should be required to tell their patients if a preventable medical error resulted in serious harm to the patient's own care.
- When asked about ways to reduce preventable medical errors, 79% of the American public said that giving doctors more time to spend with patients would be "very effective" in reducing the number of errors. Other possible solutions included requiring hospitals to develop systems to avoid medical errors (72%), better training (72%), and requiring hospitals to report all serious medical errors to a state agency (71%).
As the results of the Kaiser/AHRQ/Harvard survey show, the American public is getting more and more frustrated with the medical care they are receiving, despite ongoing efforts to make health care safer, less expensive and more effective. In addition to a perceived decline in the quality of care, the public is becoming more aware of medical errors, either through their own experiences or those of family members, and when a medical error does occur, they are not always informed of the incident. In fact, the practice of withholding information about medical errors appears to be so prevalent that many people don't expect their doctor to inform them of an error when it happens.
So, what can be done to not only improve the quality of health care in the U.S., but to improve the average American's perception of the health care system? According to Kaiser Family Foundation President Drew Altman, one of the difficulties lies in determining what the American public perceives as "real progress."
"This survey shows that the challenge is not just to improve patient safety, but to convince the public that real progress is being made," said Dr. Altman.3
Added Dr. Carolyn Clancy, an executive at AHRQ, "Many steps have been taken to improve patient safety, and the greater use of health information technology is one of the most promising developments in this area. However, these are largely 'system-related' improvements that aren't always apparent, even though consumers may recognize their importance. Our challenge is to show the connection between these kinds of changes and improving the care patients receive, while at the same time expanding and accelerating those efforts."
The complete results of the Kaiser/AHRQ/Harvar d National Survey on Consumers' Experiences With Patient Safety and Quality Information are available at the Kaiser Family Foundation's Web site (www.kff.org).
- Kohn LT, Corrigan JM, Donaldson MS (eds.) To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academy Press, 1999.
- Kaiser Family Foundation, Agency for Healthcare Research and Quality, and Harvard School of Public Health. National Survey on Consumers' Experiences With Patient Safety and Quality Information. Published November 2004. Available at www.kff.org.
- Five years after IOM report on medical errors, nearly half of all consumers worry about the safety of their health care. Kaiser Family Foundation press release, Nov. 17, 2004.