Thursday, December 3, 2009

Perspective: 10 years after “To Err is Human”

To Err Is Human Blog Series Logo

This post is part of our two-week series commemorating the 10-year anniversary of the seminal IOM Report "To Err Is Human." To see all posts in the series, please click here.

We caught up with Lori Melichar, senior program officer for the Robert Wood Johnson Foundation’s Interdisciplinary Research Initiative, to talk about the influence the IOM report on medical errors had on her work, the Foundation’s direction and the role of nurses in patient safety.

“Though the report has always been in my peripheral vision, it has influenced a lot of my work I have been involved with at the Foundation,” explains Melichar, Ph.D., M.A., a labor economist and senior program officer in the Foundation’s Research and Evaluation Unit. The IOM report, Melichar says, helped show researchers what tools would be needed to fix the problem and helped shape research agendas.

“The report scared the public in a way they hadn’t been scared before,” she said, referring to the report’s alarming statistics that as much as 98,000 patients die every year as a result of medical errors. Though the Robert Wood Johnson Foundation had been concerned about quality of care for a long time, this report created the momentum, the partners and the framework to make the investment in research aimed at finding solutions to the problem.

The Foundation knew that the role nurses play in keeping patients safe would be integral to the ambitious goals for improving safety that the IOM report laid out. “It was clear, in 2002 that the contributions nurses were making daily to patient care outcomes were invisible. After consulting with the nursing field, the Foundation decided to support a natioinal quality forum effort to endorse a set of valid, reliable quality measures linked to nursing,” Melichar remembers.

In early 2005, the Foundation began looking at ways to build the evidence base that could address gaps identified by the National Quality Forum steering committee that endorsed a set of “nursing-sensitive” quality measures. And the newly created INQRI program set about supporting the development and testing of measures that could provide a window into nurses’ positive contributions to care and guide improvements in the care delivered by nurses.

Most recently, Melichar has been acting as director of research for The Initiative on the Future of Nursing at the Institute of Medicine, a two-year joint effort of the IOM and RWJF to find solutions to biggest challenges in the nursing profession. A committee will issue recommendations next September that are intended to transform the future of nursing.

This IOM report should not scare the public however. “The nursing field is ready for action now. We have measures. We have models and we have evidence that these models work,” she says of the mission ahead.

Melichar is encouraged that those outside of nursing will embrace the report's recommendations by one recent sign: Quality of nursing care is now being included in rankings by U.S. News & World Report on hospital care. “It’s a big deal,” she said, noting that the real trick will be using the right measures that “really capitalize on nurses’ true value.”

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