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 A Global Problem Health care is a complex system that can go wrong in many different ways. At best this results in inefficiency, delay and irritation. At worst, patient safety may suffer, resulting in injury or even death to patients receiving care. Preventable harm in the health care environment - that which is caused by the processes of health care rather than an underlying disease or external accident - is known as "iatrogenic harm". Tragically, this kind of harm to patients is all too common. The risk of iatrogenic death being associated with admission to an acute care hospital is 40 times greater than that of dying from a traffic accident and 400 times greater than the risk of death associated with working in the chemical industry4. Analysis of large studies in the US and Australia (supported by smaller studies in the UK, New Zealand and Denmark) have shown that one in ten admissions to acute care hospitals is associated with an adverse event and that one in five of these contribute substantially to death (0.3% of admissions) or major disability (1.7% of admissions) 5, 6. The direct medical costs of iatrogenic harm are estimated to amount to 5% of the total amount spent on health care with a further 1% consumed by litigation and compensation. Unfortunately, this is only part of the cost. "Whole of life" costs for those who suffer harm, the people who care for them and those who provided the health care are estimated to be at least twice this amount and do not include the emotional costs to those involved4.
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