Still Not Safe: Patient Safety and the Middle-Managing of American Medicine (Original PDF)

The term “patient safety” rose to popularity in the late nineties, as the medical community — in particular, physicians working in nonmedical and administrative capacities — sought to raise awareness of the tens of thousands of deaths in the US attributed to medical errors each year. But what was causing these medical errors? And what made these accidents to rise to epidemic levels, seemingly overnight?Still Not Safe is the story of the rise of the patient-safety movement — and how an “epidemic” of medical errors was derived from a reality that didn’t support such a characterization. Physician Robert Wears and organizational theorist Kathleen Sutcliffe trace the origins of patient safety to the emergence of market trends that challenged the place of doctors in the larger medical ecosystem: the rise in medical litigation and physicians’ aversion to risk; institutional changes in the organization and control of healthcare; and a bureaucratic movement to “rationalize” medical practice — to make a hospital run like a factory. If these social factors challenged the place of practitioners, then the patient-safety movement provided a means for readjustment. In spite of relatively constant rates of medical errors in the preceding decades, the “epidemic” was announced in 1999 with the publication of the Institute of Medicine report To Err Is Human; the reforms that followed came to be dominated by the very professions it set out to reform. Weaving together narratives from medicine, psychology, philosophy, and human performance, Still Not Safe offers a counterpoint to the presiding, doctor-centric narrative of contemporary American medicine. It is certain to raise difficult, important questions around the state of our healthcare system — and provide an opening note for other challenging conversations.