Restarting a Stalled Policy Revolution: Patient Safety, System Error and Professional Responsibility

Award Year: 2005	Investigator: Charles Bosk	Budget: $282,281	Categories: Patient Safety
Abstract: The numbers were shocking: As many as 98,000 people die each year in America from medical errors. That was the attention-grabbing statistic from a groundbreaking 1999 Institute of Medicine report, To Err is Human: Building a Safer Health Care System. In the aftermath of the study, most assumed change would be swift and sure. But more than six years later, progress in reducing medical errors remains elusive, which has inspired Charles L. Bosk, Ph.D. to probe the disconnect between safety theory and safety practices in the American medical system. His project, Restarting a Stalled Policy Revolution: Patient Safety, System Error, and Professional Responsibility, considers what it will take to translate safety policies developed in academic medical centers into tangible practices at the patient's bedside. Bosk's 1979 book, Forgive and Remember: Managing Medical Failure, remains highly regarded as a definitive analysis of medical ethics and physician culture. His latest project will consider, among other things, how the "systems approach" to dealing with medical errors jibes with the physician's traditional emphasis on individual autonomy and responsibility. Bosk's insights will help identify those interventions for reducing medical errors that are most likely to succeed.