The Performance Gap
Despite widespread recognition of patient safety as a public health issue since at least 1999, preventable patient harm still occurs. Estimates suggest that the problem may be getting worse not better, although arguably the larger and more alarming estimates now are a product of more effective measurement. For example, deaths due to medical error in United States hospitals were estimated at 180,000 annually by the landmark Harvard Medical Practice Study in 1984 \cite{Leape_1994}. New research in 2016 suggest that U.S. hospital deaths attributed to medical error are 250,000, making it the 3rd largest cause of death \citep*{Makary_2016}. Existing research or public health data still lacks the ability to reliably estimate preventable harm due to missed, wrong or miscommunicated diagnoses \cite{services}. And data on harm due to medical error in non-acute care settings are still just guesses.
Whatever the estimates the challenge before us is huge and touches billions of people worldwide. The promising news is that collaborative efforts among healthcare provider organizations, thought leaders and policymaking bodies, payors positioned to incentivize achievement of expected outcomes, innovators and researchers, educators, nonprofit/non-governmental advocacy groups, product makers and activated people who use healthcare can make a difference. Through focused attention and aligned efforts in the United States driven by the Centers for Medicare and Medicaid Services (CMS), measurable patient harm was reduced by 21% between 2010 and 2015, resulting in 125,000 few deaths, 3 million fewer injuries and $28 billion in saved costs \cite{quality}. At the local level, collaboration between the public health sector, hospitals and outcomes improvement experts reduced hospital readmissions by 7,000 in Minnesota between 2011 and 2013, enabling patients in Minnesota to spend 28,120 nights sleeping in their own beds instead of the hospital, and helping reduce healthcare costs by more than $55 million \cite{McCoy_2014}.
Person and family engagement -- often referred to as "patient" and family engagement or "PFE" -- is a still an underutilized resource and strategy for achieving the goal of zero harm. Users of healthcare and their family members usually play substantial roles in managing care and often see and learn things that care providers and researchers miss. Moreover, persons who use care or manage its use for loved ones are typically highly motivated to partner with their professional and organizational care providers to improve safety. In 2006 the World Health Organization captured this willingness to partner in the London Declaration of its Patients for Patient Safety group, a core component of its Global Patient Safety Programme \cite{program}: