The article titled To Err Is Human: Failing to Reduce Overall Harm Is Inhumane by Pronovost, Austin, and Milstein (2025) presents a critical reflection on the enduring and systemic safety failures in the U.S. healthcare system. Despite the decades since the original To Err is Human report by the Institute of Medicine, the authors argue that healthcare remains dramatically less safe than other high-risk industries like aviation. They cite recent data indicating that one in four hospitalized patients in the U.S. continues to experience harm, including from medication errors, surgical complications, and diagnostic failures.
The authors attribute this persistent safety gap to multiple interrelated structural and governance issues. First, federal accountability for patient safety is described as ambiguous and fragmented, with no central figure or agency directly responsible for safety oversight in the Department of Health and Human Services (HHS). In contrast, the aviation industry’s safety accountability is clearly centralized under the Secretary of Transportation. Second, the article highlights the lack of timely and transparent harm reporting in healthcare. Unlike aviation, which uses real-time incident tracking and public reporting systems, healthcare predominantly relies on claims data with significant reporting delays and validity concerns.
A major point emphasized by the authors is the absence of sector-wide collaborative mechanisms in healthcare to identify and correct safety issues. They advocate for the creation of a national body akin to the Commercial Aviation Safety Team to drive systemic risk analysis and engineering-based interventions. The current reliance on re-education and piecemeal interventions, often varying even across hospital units, is criticized as inadequate.
Furthermore, the article critiques the accreditation process overseen by bodies like The Joint Commission and DNV Healthcare. These organizations are characterized as lacking rigorous, scientific harm measurement standards and being influenced by conflicts of interest, as hospitals choose and pay their own reviewers. The authors recommend modernizing the Centers for Medicare and Medicaid Services (CMS) conditions of participation by embedding principles of safety engineering and shared accountability. Proposed reforms include requiring hospital executives to review harm rates and action plans directly with accrediting bodies, and publicizing both high- and poor-performing institutions to drive improvement through transparency and positive deviance models.
Ultimately, Pronovost and colleagues call for urgent and bold reforms to reduce harm rates meaningfully. They argue that the persistence of preventable harm, despite decades of awareness and sporadic efforts, represents a moral failure. Strengthening accountability, data transparency, and systemic safety science implementation are presented as essential steps to making healthcare safer for all Americans.
APA Reference:
Pronovost, P. J., Austin, J. M., & Milstein, A. (2025). To Err Is Human: Failing to reduce overall harm is inhumane. American Journal of Medical Quality, Advance online publication. https://doi.org/10.1097/JMQ.0000000000000250
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