Learning by accident: Q&A with Patricia Horoho

Patricia Horoho, Lieutenant General in the U.S. Army and the first woman and first nurse to serve as the Army’s Surgeon General, revealed how health care can cause harm by sins of commission and omission. We followed up with Patricia to answer a few additional questions about her topic.

Patricia Horoho at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED]
Patricia Horoho at TEDMED 2014 [Photo: Sandy Huffaker for TEDMED]

What motivated you to speak at TEDMED?
TEDMED presented a wonderful opportunity to present a difficult subject in a supportive environment. The other speakers, facilitators, and the audience provided a unique opportunity to participate in a remarkable forum. I also saw TEDMED as an opportunity to clearly demonstrate that Army Medicine isn’t afraid to confront the issues of medical errors and harm.

Why does this talk matter now? What impact do you hope the talk will have?
The facts aren’t new – we’ve known about the tremendous cost in lives and health of medical errors for at least a decade. Many leading healthcare institutions and researchers have addressed the issue, but we still haven’t made significant progress in addressing the underlying root causes. TEDMED allowed me the opportunity to highlight existing research and present the issue from my vantage point as the Army Surgeon General. I have traveled around the globe since TEDMED talking to Army Medical teams about the subject of preventable harm.

What kind of meaningful or surprising connections did you make at TEDMED?
The opportunity to talk with Delegates after my talk was incredibly rewarding. Many shared with me their personal experiences of medical harm or the challenges of getting their organizations to recognize and address the problem. What I heard over and over again was that the fear of litigation or the shame of making a human error kept good people and organizations from openly discussing the issue.

How has the military responded to your talk and your message about preventable harm?
I found that Army Soldiers and their families appreciated our collective willingness to discuss preventable harm on a national stage. Thousands of military health professionals are engaged in the detailed work that is required to turn the dial down on preventable harm.

I think the military medical community received the talk generally the same way the civilian healthcare community did. As you might expect, there were at least two major groups: 1), those who recognize the problem of preventable harm across American medicine and welcome the discussion even though it is uncomfortable and 2), those who don’t believe there is a problem or think that the issue is being blown out of proportion. The latter group often doesn’t appreciate the difference between “harm” and “preventable harm.” In medicine, we talk about “adverse events” which is a sterile euphemism for harm. However not all adverse events are the same. Some, in fact most, occur due to circumstances that are not under the control of healthcare professionals. When we talk about preventable harm, Army Medicine is addressing both the human and system errors that reach the patient and cause unnecessary harm. These human and system errors can be anticipated and we can improve our processes to ensure that they don’t reach our patients.

What’s next for you?
In the next weeks and months, I will continue to travel to Army Medicine facilities around the world speaking face-to-face with the leadership of every Army hospital about how we will eliminate preventable harm. In addition, I have opportunities to share Army Medicine successes and challenges with numerous members of Congress and oversight committees.