The Financial and Human Cost of Medical Error

... and How Massachusetts Can Lead the Way on Patient Safety

There has been considerable progress on improving the safety of health care for patients over the past two decades, particularly in hospitals in Massachusetts and across the country.

Yet preventable deaths and injuries associated with medical error persist. As more complex care is delivered outside of hospitals, risks to patient safety are an emerging concern anywhere patients receive care. Systems for keeping patients safe have not always kept up with the increasing complexity of health care delivery.

The challenges are great, but so are the opportunities for improvement — particularly in Massachusetts. Our report, The Financial and Human Cost of Medical Error … and How Massachusetts Can Lead the Way on Patient Safety, details two sets of research findings and also proposes a coordinated response through which the Commonwealth’s providers, policymakers, and public can accelerate safety and quality improvement and lead the nation on this urgent health care challenge.

"While there are no easy fixes, a sustained, collaborative statewide effort can harness a lot of work that’s already been done here and elsewhere to accelerate the pace of safety improvement."
- Barbara Fain, Executive Director, Betsy Lehman Center for Patient Safety

Key Takeaways

Medical errors are frequent, harmful, and costly

Our research identified almost 62,000 preventable harm events and more than $617 million in excess health care insurance claims — just exceeding one percent of the state’s Total Health Care Expenditures for 2017. Because some of the most common types of errors, such as medication and diagnostic error, cannot be reliably identified through health insurance claims data, these numbers underestimate both total incidence and cost.

Errors have long-lasting impacts on physical and emotional health

Survey respondents described significant, persistent physical and emotional harms from medical errors. Almost 30 percent stated that their physical health (or the physical health of the household or family member to whom the error happened) was impacted at least to some degree for one year or more. An additional 12 percent were family members of a person who reportedly died.

Among respondents who reported that the error happened 3-6 years before the survey, one-third reported that they still feel anxious, more than a quarter continue to feel sad or angry, and just over one in five say they are depressed.

Medical errors are associated with long-lasting loss of trust and avoidance of health care

Two-thirds of respondents expressed reduced levels of trust in health care no matter how long ago the error occurred. Well over half of people whose error happened 3-6 years ago said that they sometimes or always continue to avoid the individual doctors (57%) or the health care facility (57%) involved in the error.

Of great concern is that more than one-third of all respondents report that they continue to sometimes or always avoid all medical care.

Open communication is linked to lower levels of adverse emotional impacts and health care avoidance

More than 60 percent of respondents were dissatisfied with the communication from their provider after the error. But when providers communicate openly about the error, patients report lower levels of emotional harm.

Open communication has a similar effect on reducing health care avoidance, from 45 percent (without open communication) to 26 percent (with open communication).

Patients and families are astute observers of what, where and why things went wrong

Although there were many cases of severe injury in the course of intensive treatment, respondents often described preventable injuries that happened during routine care. They perceived the underlying causes of the errors to range from breakdowns in systems and communications, to workforce factors. They often expressed empathy for the staff involved in the errors, noting that they seemed stressed, harried, burnt out or otherwise unable to do their jobs well under current constraints.

Nearly 40 percent of respondents didn’t discuss the error with anyone other than family and friends, primarily because they believed it “would not do any good.” Of those who did, almost two-thirds (62%) said they hoped to prevent harm to future patients by speaking up. Lawyers were consulted just seven percent of the time, while errors were reported to government agencies only one percent of the time.

The Financial and Human Cost of Medical Error

... and How Massachusetts Can Lead the Way on Patient Safety

Charts and graphics

News coverage

Medical errors prevalent and costly, Boston Globe (June 2019)
No drop in medical errors but human toll endures, CommonHealth WBUR (June 2019)

Open communication and the impact of medical errors

An in-depth article based on Cost of Medical Error research, published in BMJ Quality and Safety and first-authored by Julia Prentice, PhD, Research Director at the Betsy Lehman Center