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6 January 2004 | Volume 140 Issue 1 | Pages 33-36
Ensuring patient safety is essential for better health care, but preoccupation with niches of medicine, such as patient safety, can inadvertently compromise outcomes if it distracts from other problems that pose a greater threat to health. The greatest benefit for the population comes from a comprehensive view of population needs and making improvements in proportion with their potential effect on public health; anything less subjects an excess of people to morbidity and death. Patient safety, in context, is a subset of health problems affecting Americans. Safety is a subcategory of medical errors, which also includes mistakes in health promotion and chronic disease management that cost lives but do not affect "safety." These errors are a subset of lapses in quality, which result not only from errors but also from systemic problems, such as lack of access, inequity, and flawed system designs. Lapses in quality are a subset of deficient caring, which encompasses gaps in therapeutics, respect, and compassion that are undetected by normative quality indicators. These larger problems arguably cost hundreds of thousands more lives than do lapses in safety, and the system redesigns to correct them should receive proportionately greater emphasis. Ensuring such rational prioritization requires policy and medical leaders to eschew parochialism and take a global perspective in gauging health problems. The public's well-being requires policymakers to view the system as a whole and consider the potential effect on overall population health when prioritizing care improvements and system redesigns.
Author and Article Information
From Virginia Commonwealth University Medical Center, Richmond, Virginia.
Acknowledgments: The author thanks Anton J. Kuzel, MD, MHPE; Alex Krist, MD; Richard M. Frankel, PhD; John D. Engel, PhD; Valerie J. Gilchrist, MD; Charles Vincent, PhD; and the anonymous reviewers for their helpful suggestions on this manuscript.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Steven H. Woolf, MD, MPH, Departments of Family Practice, Preventive Medicine, and Community Health, Virginia Commonwealth University, 3712 Charles Stewart Drive, Fairfax, VA 22033; e-mail, swoolf{at}vcu.edu. IMPROVING PATIENT CARE
Improving Patient Care is a special section within Annals supported in part by the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this article are those of the authors and do not represent the position or endorsement of AHRQ or HHS.
Patient Safety Is Not Enough: Targeting Quality Improvements To Optimize the Health of the Population
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