In Reply “The goal is zero harms” has resonated throughout patient safety. Two decades after To Err Is Human, health care continues to face recurrences of a multitude of preventable adverse events. No guideline, policy, or public health intervention has been able to eliminate adverse events.
Eldridge et al1 illustrated this fact well—adverse event rates affect millions of people. Statistically significant shifts in rates of 21 health outcomes using big data make for publishable findings, but millions fewer adverse events implied by these rates do not comfort millions of patients still harmed. There is inherent risk in seeking health care, just like traveling by airplane. However, the airline industry has managed to reduce accident rates from more than 50 per 1 million flights in the 1960s to only 1 to 2 per 1 million flights today. The airline industry measures defects per million, whereas health care still measures adverse event cases per 1000. Top-down, systematic approaches to quality improvement combined with prospective data collection and methodologically rigorous assessment of trends has led to better outcomes in other industries, and could also benefit health care.