Still Not Safe: Patient Safety and the Middle-Managing of American Medicine

by Robert Wears, Kathleen Sutcliffe

The term "patient safety" rose to popularity in the late nineties, as the medical community -- in particular, physicians working in nonmedical and administrative capacities -- sought to raise awareness of the tens of thousands of deaths in the US attributed to medical errors each year. But what was causing these medical errors? And what made these accidents to rise to epidemic levels, seemingly overnight?

Still Not Safe is the story of the rise of the patient-safety movement -- and how an "epidemic" of medical errors was derived from a reality that didn't support such a characterization. Physician Robert Wears and organizational theorist Kathleen Sutcliffe trace the origins of patient safety to the emergence of market trends that challenged the place of doctors in the larger medical the rise in medical litigation and physicians' aversion to risk; institutional changes in the organization and control of healthcare; and a bureaucratic movement to "rationalize" medical practice -- to make a hospital run like a factory.

If these social factors challenged the place of practitioners, then the patient-safety movement provided a means for readjustment. In spite of relatively constant rates of medical errors in the preceding decades, the "epidemic" was announced in 1999 with the publication of the Institute of Medicine report To Err Is Human; the reforms that followed came to be dominated by the very professions it set out to reform.

Weaving together narratives from medicine, psychology, philosophy, and human performance, Still Not Safe offers a counterpoint to the presiding, doctor-centric narrative of contemporary American medicine. It is certain to raise difficult, important questions around the state of our healthcare system -- and provide an opening note for other challenging conversations.

Genres: Health, Nonfiction

304 pages, Hardcover

First published November 1, 2019

Reviews

[Tyler Jones · Rating 3 out of 5]

Good message but not very well written. It reads like a typical academic text—as if you’re driving down a road with a speed bump on every block.

[Reed · Rating 5 out of 5]

A very interesting review of the patient safety movement and how it has been transformed over the past 30 years from an advocacy for reform to a bureaucratic cataloging of numbers and events hoping to find a "cause" in the process. According to the authors, the workplace, especially in healthcare is a dynamic process forever changing and cannot be constrained to number counting in search for a causative event - a place to lay blame. In a dynamic process, it is the system that is in need of scrutiny and analysis and not the individual events contained within the system. The "medicalization" of the patient safety movement has placed it under the hegemony of bureaucratic-industrialized medicine and rendered the movement with little hope of truly understanding the basis (social and psychological as opposed to medical) of accidents in healthcare delivery. Great writers.

[Alaina Darby · Rating 4 out of 5]

I enjoyed getting a different perspective. From what I've heard during my entire training as a pharmacist. I hear a lot about the initiatives mentioned in the book and the research behind them. I do think we take this as gospel without stopping to think who is pushing those initiatives. It was definitely an interesting perspective.

[Ayla · Rating 3 out of 5]

3.5/5 ⭐️ - definitely read like a textbook but this was a great pick for our work book club. While a lot of the book was focused on health policy, there was still a lot of applicability to the medtech R&D space.

[Myrtede Alfred · Rating 3 out of 5]

Great accounting of the patient safety movement in the US.

[Roxanne McCarley · Rating 3 out of 5]

Helpful context and history of this movement. Could have edited down the recommendations piece because that seemed fairly straightforward.

[April Carmack · Rating 3 out of 5]

3.5

[Sushila · Rating 5 out of 5]

Still Not Safe is one of the best "medical" books I have read in recent memory. Drs. Wears and Sutcliff argue that the patient safety movement may have started with good intentions but that it has been bogged down by egoism, misinterpretation, narrow-mindedness, bureaucracy, and in some cases selfishness. The book is incredibly well-written. It combines the best parts of an academic paper (research, references, rigor) and a New Yorker article (excellent prose, readability). I highlighted so many sections!

I particularly liked learning about the origins of the patient safety movement and how successes were often due to the work of engineers and organizational scientists. (Also, it was nice to see anesthesiology recognized and lauded for once!) It also made me personally excited because it took me back to some of my engineering background as an undergraduate.

I highly recommend Still Not Safe. Hopefully people of many backgrounds will read it. Even though the authors present well-backed criticisms of the patient safety movement, they seem hopeful. I took away a call for real restructuring and creativity.

[Paul Gimson · Rating 5 out of 5]

Fantastic challenge to the patient safety orthodoxy

Important read for anyone involved in safety and Improvment. Describes how past efforts have been hampered by rigid thinking and an undereliance on psychology and engineering