Interesting timing; I spent this morning in a risk management simulation: a mock hospital, with actors playing patients, surrounded by a bunch of doctors criticizing me when anything I did looked like it left potential open for a medical error. This was part of about fifty hours or so of training specifically in avoiding medical errors I've gone through in the past four years. Also, my record for "number of different doctors who have mentioned Atul Gawande to me in a single day" currently stands at three, and I'm expecting it to be broken before finishing school in May. It's safe to say any trend that's reached medical schools in southwestern Ireland is well established in the States, Britain, and the rest of the world.

There are dozens of journals, textbooks, and three-letter-acronym organizations dedicated solely to healthcare risk management, and most good hospitals will have their own on-site risk management team. Newer paper hospital charts have been specifically designed around risk management (for example, on the charts I used today, there are two spaces to sign for giving any drug: the signature of the person who gave it, and that of the person they checked it with to make sure it was safe), and those hospitals that have electronic charts have their built-in measures to prevent errors (for example, they'll automatically pop up an alert if you prescribe an unusual dose of any drug, or two drugs that interact with each other, or a drug a patient is known to be allergic to; sometimes only certain authoritative staff at the hospital have the password to override these alerts.)

Now, none of this means that risk management is any good. You're still making a bunch of chronically sleep-deprived and very busy people play a game of Chinese whispers with complicated biochemical data. And I sort of worry that some hospital manager has done the math and decided that the amount of money saved in malpractice suits is less than what it would cost to hire lots of extra doctors so each one is individually less busy and more awake.

But I do think that once there are thousands of people and tens of millions of dollars in a field, you don't get to call it "hiding in plain sight" or "low hanging fruit" anymore.