Patient Safety and Dentistry: 20 years after “To Err is Human”

Posted Aug 17th, 2020 in the wire, thought leadership, 2020

Julian Perez, Vice President of Risk Management & Compliance, dentalcorp


Dentistry is inherently risky. How many things can go wrong? A paper published in 2016 in the Journal of the American Dental Association counted 747 unique ways dental care could result in injury.  

Most of the time, things go right, because dental professionals care for their patients and try hard to avoid adverse events.  But trying hard is not always good enough.  Once an activity passes a critical threshold of complexity, skill and effort no longer guarantee safety. The classic example is landing a jumbo-jet, on a crowded runway at night, after 12 hours in the air.  Yet that activity is far safer than healthcare.

In 2016, accidents of civil airliners resulted in only 325 fatalities. That same year, a Johns Hopkins study estimated more than 250,000 people died in the USA alone due to medical error.

In dentistry, deaths are rare; however, adverse events are not. A 2013 study from the Netherlands assessed 1,000 patient charts and while adverse errors were found in only 5%, the real frequency is likely much higher. Of the adverse events that were found, 40% were preventable. Many dental adverse events consist of minor injuries; nevertheless, errors are costly in terms of loss of trust by patients and diminished satisfaction by patients and health professionals.

We can do better. The modern patient safety movement began twenty years ago when the Institute of Medicine published “To Err is Human.” The central conclusion of To Err is Human was that hiring great doctors is not enough to eliminate preventable errors. Rather, improving safety means changing systems, processes, and attitudes. The introduction of safety checklists is a prime example of a process change founded on the principle that human error is inevitable. Checklists have been commonplace in aviation for decades, because airlines realized that even the best pilots eventually lose situational awareness and focus.

Thus, the first lesson dentistry should take from aviation is that appropriate processes and intelligent systems can make errors far less likely. Over the past ten years, checklists have slowly started to gain acceptance within dentistry.  

The second takeaway also relates to failure. Every commercial aircraft comes equipped with a black box. When there is an accident, the box is located, analyzed, and the reason for the accident investigated. When required, procedures are changed so the same event doesn’t happen again.  Pilots, manufacturers, government agencies and airlines share this information for the benefit of all.

Dentistry needs to reconsider its relationship with adverse events. Instead of denying them, or trying to forget, aviation teaches us to embrace them. So, the next time something goes sideways, talk about it. Share it with your colleagues. Bring it up at a study club. If nothing else, share it with Compliance. Learning from the misadventures of others is one of the best ways to improve patient safety and the benefit of working in a network.


About the Author

Julian Perez is the Vice President of Compliance & Risk Management at dentalcorp and is responsible for the development, implementation, and oversight of company-wide standards, programs, and systems to support practices in the delivery of optimal patient care. Julian has a robust legal background having worked for a Wall Street law firm in Manhattan as well as a professional liability program providing malpractice defense to over 10,000 dentists. Julian holds a bachelor’s degree from Yale University and a juris doctorate from Columbia University’s School of Law.

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