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Army surgeon general focuses on patient harm during TEDMED talk

By Ron Wolf | Army Medicine | Oct. 3, 2014

JBSA-FT SAM HOUSTON — Lt. Gen. Patricia Horoho, surgeon general of the Army, delivered a live TEDMED talk Sept. 11 titled "Don't you dare talk about this," at the Kennedy Center in Washington, D.C.

Horoho aimed to refocus national attention and provide insights on the problem of preventable harm in U.S. hospitals.

TEDMED - which stands for technology, entertainment and design - talks are the medical and health version of the internationally known and highly regarded TED conferences.

The short talks bring together the most innovative and forward-thinking minds to share "ideas worth spreading" and have been viewed online more than 2 billion times.

Horoho compared the consequences of patient harm to Pearl Harbor and the Sept. 11 attacks. More than 2,300 died at Pearl Harbor and more than 2,900 died on Sept. 11, 2001. However, those were one-day totals, she explained.

Every day, more than 1,100 people die in U.S. hospitals due to preventable harm, which adds up to more than 400,000 each year.

"Preventable harm in our hospitals is much worse than these acts of war," Horoho said. "We expect harm from acts of war, and we can plan and prepare for it. However, we do not plan or even expect preventable harm to happen in our hospitals. As a result, harm is talked about in metaphors, such as 'near misses, unintended complications, and close calls.'"

Preventable harm and the deaths associated with it have been mentioned previously in widely known reports. The Institute of Medicine, or IOM, published "To Err is Human: Building a Safer Health  System," in 1999, in which the IOM estimated that as many as 98,000 deaths occurred each year as a result of medical error.

That figure from the IOM falls far short, however, of the number of deaths estimated in 2013, when the Journal of Patient Safety put the number of deaths each year for preventable harm at closer to 400,000.

Horoho made the point that we have done essentially nothing about this problem. Silence on this topic by the medical community is the main cause that allows preventable harm to continue, she said.

Reducing preventable harm is part of the transformation of healthcare that will reduce costs and improve access. Hospital safety and patient confidence in the safety of care they are receiving is a critical part of promoting health and wellness as well, an important part of the transformation of Army Medicine.

"We can eliminate preventable harm," she said. "The problem is not the errors. The problem is that we ignore the errors. But in our U.S. hospitals, we talk about harm in hushed tones. We use metaphors. We talk about near misses, unintended complications, and close calls. To err is human."

Horoho issued a call to action.

"As individuals, we need the confidence, the integrity and the courage to speak up," she said. "As leaders, we need to listen to our patients, to our families, and to our staff. If we decide our system isn't working, we can change it."

"By addressing the errors, we can prevent harm," she said. "We can do this, and I believe the time is right. The enemy is our silence; our ambivalence, our complacency, our lack of confidence; silence kills."