Madam, - Most medical errors stem from system failures rather than individual failings. Understandably, many doctors feel oppressed by the term "medical error", feeling it implies that medical errors are always due to the failings of doctors. But errors usually originate in a variety of systemic features - the task, the team, the work environment, the organisation. Typically, 85 per cent of errors can be attributed to the system rather than to an individual.
The organisation of systems requires management skills, but unfortunately, these are not taught in medical school - and, too often, they are not valued by doctors, who have a strong culture of individualism.
Until recently, when errors occurred in hospitals, the response was to conduct superficial investigations which ended up blaming individuals rather than analysing the true systemic causes of the events. When things go wrong, blaming individual staff - often nurses and doctors at the sharp end of health care - is legally convenient and emotionally satisfying. But it does nothing to prevent similar errors occurring in future. To reduce errors, medical and managerial leadership in hospitals must work together to discharge their joint responsibilities for the system.
Errors in health care have now become a major public health policy issue in Ireland. Yet in recent weeks several prominent medical leaders have questioned the scale of the problem and suggested that much of it is media hype. But we would be unwise to ignore the lessons from countries where studies on the incidence of medical error have been done, such as the United States, Britain and Australia. It is unfortunate that we do not have local research evidence, but this is no excuse for procrastinating. - Yours, etc.,
TIM DELANEY, MPSI, Head of Pharmacy, The Adelaide and Meath Hospital, Tallaght, Dublin 24.