Editorials

Reducing errors in medicine

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7203.136 (Published 17 July 1999) Cite this as: BMJ 1999;319:136

It's time to take this more seriously

  1. Donald M Berwick, Chief executive officer,
  2. Lucian L Leape, Adjunct professor of health policy
  1. Institute for Healthcare Improvement, Boston, MA 02215, USA
  2. Harvard School of Public Health, Boston, MA 02115, USA

    “Ladies and gentlemen, welcome aboard Sterling Airline's Flight Number 743, bound for Edinburgh. This is your captain speaking. Our flight time will be two hours, and I am pleased to report both that you have a 97% chance of reaching your destination without being significantly injured during the flight and that our chances of making a serious error during the flight, whether you are injured or not, is only 6.7%. Please fasten your seatbelts, and enjoy the flight. The weather in Edinburgh is sunny.”

    Would you stay aboard? We doubt it.

    Luckily, the safety statistics in airline travel are far, far better than these figures. Between 1990 and 1994 United States airline fatalities were 0.27 per 1 000 000 aircraft departures, less than one third the rate in mid-century, despite vast increases in the complexity and volume of our aviation systems. One estimate is that a modern passenger would have to fly continuously for 20 000 years in order to reach a 50% chance of injury in an airplane accident.

    In health care it is a totally different story. With the rising complexity and reach of modern medicine have come startling …

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