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Swiss cheese and American medical mistakes: How can prevention improve?

"Who Moved My Cheese?" was a popular business book a few years ago. It explored the idea that the constancy of change means rewards may not always continue to come from the same place.

Today, another cheese image is circulating in organizational theory. The image is that of a particular type of cheese, namely Swiss.

In simplified form, the Swiss cheese theory holds that preventing risks in complex systems is like stacking up multiple layers of Swiss cheese, one behind the other. To prevent accidents, there need to be layers of defense that aren't dependent on the other layers, so that a hazard does not get through all of the holes.

How is preventing medical malpractice like stacking up these Swiss cheese layers?

Changing medical professionals' behavior

The New York Times recently devoted a lengthy editorial to the status of efforts to prevent medical errors by making the delivery of services more evidence-based and driven by standard protocols. In some health systems, protocols such as surgical checklists have had documented success in preventing errors and producing better outcomes.

The U.S. health care system is so vast, however, that is it difficult to bring about comprehensive change. As the Times noted, there are more than 35 million hospital admissions every year. And the number of ER visits is even higher, at 136 million.

In practice, what this means is that the medical care you get depends greatly on where you are. There are lots of evidence-based best practices out there now. But how well are they being implemented at the particular hospital or clinic you go to? And how effective are the particular doctors and other professionals there at using those best practices?

Filling the holes in the Swiss cheese of the medical system

This is where the Swiss cheese imagery we mentioned earlier comes in. In order to properly protect patients from medical mistakes, it is necessary to build in multiple layers of defense.

One layer could very close to home: the patient advocates we talked about in our August 12 post. Having an advocate with you in the hospital helps to guard against errors and keep the continuity of care despite many handoffs among doctors, nurses, lab techs and other professionals.

More broadly, another layer of protection could come in the form of a national initiative called the Partnership for Patients. It's a public-private network of programs sponsored by the federal Centers for Medicare and Medicaid services.

The Partnership aims to make hospitals safer, with fewer medical mistakes, hospital-acquired infections and other adverse events. Another goal is to improve transitions between one care setting to another in order to reduce the rate of hospital readmissions.

If you or someone in your family has been harmed

Another layer of defense against medical errors is the role that a skilled attorney can play in holding negligent medical providers accountable.

If you or someone in your family has been harmed by medical malpractice, coming forward with a claim isn't only about seeking proper compensation for the injuries. It's also about sending a message to the responsible party that an injury like this shouldn't happen again to someone else.

In short, a medical malpractice lawsuit can be one of the layers of Swiss cheese needed to help prevent more malpractice in the future.

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