April 5, 2022By Lance Baily

‘Still Not Safe’ Book Details Patient Safety’s Failure to Take Off

By employing healthcare simulation practices and scenarios to help train learners, clinical simulation educators are simultaneously working to help reduce medical errors worldwide. Yet as a Johns Hopkins study reports, more than 250,000 people in the U.S. still die every year from these medical errors. This fact, and the thinking that an “epidemic” of medical errors was derived from a reality that didn’t support such a characterization, led authors Kathleen M. Sutcliffe and Robert Wears to publish their book, “Still Not Safe: Patient Safety and the Middle-Managing of American Medicine” in November 2019. This HealthySimulaiton.com article shares insight into this work through an interview with Sutcliffe, a Bloomberg Distinguished Professor at Johns Hopkins Carey Business School.

In the book, Wears, a physician, and Sutcliffe, an organizational theorist, trace the origins of patient safety to the emergence of market trends that challenged the place of doctors in the larger medical ecosystem. These trends include 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. The authors describe the last trend as if to make a hospital run like a factory.

Further, they share that, if these social factors challenged the place of practitioners, then the patient-safety movement provided a means for readjustment. Ultimately, the Patient Safety Movement currently works to connect the dots between all stakeholders working to advance patient safety by challenging the status quo and breaking down silos. The organization believes that the medical community must work together, in step, to educate everyone who is a piece of the puzzle and create public demand for safe and reliable patient care.

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HealthySimulation.com: When did you begin working on “Still Not Safe,” and where did the idea for the book stem from?

Kathleen Sutcliffe: My collaborator, the late physician Dr. Bob Wears (1947-2017), and I started discussing the idea of critical analysis and the history of patient safety in 2014. The idea in part came from research we conducted that was funded by the Robert Wood Johnson Foundation. That research explored a disturbing trend that we had seen developing in the patient safety community – that the patient safety research community overtime was losing expertise and diversity. In a short period of time patient safety had come to be dominated by clinicians to the exclusion of psychologists, organizational and social scientists, and engineers who had early on in the patient safety movement brought new ways of thinking to the problem.

HealthySimulation.com: Why do you think patient safety is such an important issue?

Kathleen Sutcliffe: I think the answer to that question is obvious: No one wants to be harmed from actions undertaken to make them better. And no one wants to see harm come to their loved ones. And, generally speaking, no one trying to do good healthcare wants to harm someone else. And, in addition, harm costs: It creates suffering, it costs lives, it costs money, it costs reputations, it costs livelihoods.

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HealthySimulation.com: What are the key points of the book?

Kathleen Sutcliffe: It is a complex historical and critical analysis and it is impossible to recount the key points of the book in a sentence or two. Suffice it to say that by weaving together narratives from medicine, psychology, philosophy, and human performance we illuminate why healthcare has made so little progress in reducing patient harm.

HealthySimulation.com: Was there anything that you learned that particularly shocked/surprised you when writing this book?

Kathleen Sutcliffe: Good question. This may be heretical, but for the most part, I came away thinking that healthcare really doesn’t want to learn from that outside of healthcare.

HealthySimulation.com: Who should consider reading this book and why?

Kathleen Sutcliffe: There is a little bit of something for everyone in this book – particularly about how the patient safety movement evolved and came to its current state (which I think of as a kind of self-perpetuating bureaucracy).

REGISTER TODAY: Champions of Simulation Virtual Symposium

  • Wed. April 13th, 2022 | 8AM-4PM PDT, UTC-7
  • Join Live & View Recordings for 3 Months
  • 6 CEs Offered | CMEs in Application

This exciting CE event (CMEs in application, stay tuned) will host numerous presentations from some of the world’s leading clinical simulation experts. These include two introductions to important non-profit organizations supporting patient safety:

Introduction 1: The Patient Safety Movement Foundation

Presented by: Ariana Longley, MPH, Chief Operating Officer, Patient Safety Movement Foundation
Time: 3:30PM – 3:45PM PDT
Nursing CE Certificate: N/A

Introduction 2: The National Patient Safety Board Advocacy Coalition

Presented by: Karen Wolk Feinstein, Ph.D., President and CEO, Pittsburgh Regional Health Initiative and the Jewish Healthcare Foundation
Time: 3:45PM – 4PM PDT
Nursing CE Certificate: N/A

HealthySimulation.com: How do you hope this book impacts the medical community at large?

Kathleen Sutcliffe: I hope it keeps us honest. That is, the IOM’s To Err Is Human report published in 1999 suggested that healthcare needed to take a systems’ approach to safety and focus on the value of strong cultures. Supposedly we have been doing that over the past 20 years. Recent progress reports (analyses of progress over 20 years since the publication of TEIH) reiterate what had been advocated in 1999: a systems approach and focus on culture. Is there reason to suppose that this time it will be different? We need different approaches and different expertise.

HealthySimulation.com: What are some of the difficult, important questions about the state of our healthcare system that you believe this book should raise?

Kathleen Sutcliffe: What levels of harm are reasonable to expect? Can we get to zero harm? What types of harm are actually preventable? How can we manage the complexity of systems that are unpredictable? How can we build more adaptability into our systems?

HealthySimulation.com: What impact do you hope it has on the healthcare simulation community specifically?

Kathleen Sutcliffe: Building people’s expertise and adding to the response repertoires of people, teams, and organizations is a sure way to enhance adaptability. Simulations/scenarios are critical tools to accomplish this and provide important data to all of us.

HealthySimulation.com: In your opinion, what would it take to dramatically improve patient safety and reduce medical error over the next decade or so?

Kathleen Sutcliffe: My bet is that the next waves of innovation in safety are going to come from improving the ways people interrelate with one another and building and enacting daily work habits of thought and action that keep people alert and aware of unfolding events. We also must assure that people are continually training and developing their expertise and are aided in their work by various technologies.

HealthySimulation.com: Anything else you would like to add?

Kathleen Sutcliffe: As I noted earlier, adaptability and ultimately resilience are fueled by ordinary factors that promote competence, restore efficacy, and encourage growth. Medical simulation can contribute to enhancing all three and are important scaffolds to assuring safer care.

More About ‘Still Not Safe’

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 about the state of our healthcare system — and provide an opening note for other challenging conversations. Order “Still Not Safe” on Amazon.

More About Healthcare Simulation Books

Healthcare Simulation Books are a critical component of learning how to develop, expand, and utilize medical simulation methodologies and technologies in professional healthcare institutions to improve learning and patient safety performance outcomes. Everything from audiovisual system design, to manikin hardware, debriefing, patient simulators, nursing simulation, virtual reality, research books, surgical simulation, administrative manuals, Sim Tech guides, and more!

As educational degree pathways are extremely rare and healthcare simulation conferences take place only annually, healthcare professionals and institutions seeking to develop or expand their simulation expertise should invest heavily into the latest nursing simulation books, surgical simulation books, moulage books, and more! Have another book to share? Email us and we will add it to the list.

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