CHAPTER 3Simple Steps to a Better Hospital

The Institute of Medicine’s To Err Is Human (National Academy Press, 2000) called for a 50 percent reduction in medication errors, but in 2009, Dr. David Bates said, “With respect to the 50 percent reduction, the truth is that we don’t really know, because we don’t have good metrics for sorting out how common medical errors are in most institutions.” Atul Gawande reported in Complications (Holt, 2003) that autopsies turned up major misdiagnoses as the cause of death a shocking 40 percent of the time, and rates have not improved since 1938.

Every hospital seems to have the same issues: preventable adverse events that will no longer be paid by Medicare and other insurers.

This shows up in many ways: ...

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