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UC San Diego Electronic Theses and Dissertations UC San Diego UC San Diego Electronic Theses and Dissertations Title The challenge of patient safety and the remaking of American medicine Permalink https://escholarship.org/uc/item/38s4s7v9 Author Van Rite, Eric Publication Date 2011 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California UNIVERSITY OF CALIFORNIA, SAN DIEGO The Challenge of Patient Safety and the Remaking of American Medicine A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Sociology by Eric Van Rite Committee in charge: Professor Jeffrey Haydu, Chair Professor Steven Epstein Professor Edwin Hutchins Professor Andrew Lakoff Professor Charles Thorpe 2011 Copyright Eric Van Rite, 2011 All rights reserved. The Dissertation of Eric Van Rite is approved, and it is acceptable in quality and form for publication on microfilm and electronically: Chair University of California, San Diego 2011 iii TABLE OF CONTENTS Signature Page……………………………………………………………… iii Table of Contents…………………………………………………………… iv List of Tables……………………………………………………………….. v Acknowledgments………………………………………………………….. vi Vita…………………………………………………………………………. ix Abstract…………………………………………………………………….. x CHAPTER 1 – Introduction: The Patient Safety Challenge………………………………… 1 CHAPTER 2 – From Risk to Reform: Changing the Concept of Medical Error…………… 42 CHAPTER 3 – From Tragedy to Advocacy: Patient Stories of Transformation……………. 91 CHAPTER 4 – Making the Case for Patient Safety: Organizational Leaders & Advocacy… 140 CHAPTER 5 – Conclusion: The Politics of Patient Safety and Healthcare Reform………… 192 Appendix: Chronology of Major Events Related to Patient Safety ……….. 215 Bibliography………………………………………………………………… 216 iv LIST OF TABLES Table 1: Historically Significant Reports on Medical Error ……………… 90 (Medical Insurance Feasibility Study, Harvard Medical Practice Study, and To Err is Human) Table 2: Prominent Medical Error Narratives……………………………… 139 (Advocacy Stories of Betsy Lehman, Sorrel King, and Dennis Quaid) Table 3: Major Patient Safety Advocacy Organizations…………………… 191 (National Patient Safety Foundation, Institute for Healthcare Improvement, and World Alliance for Patient Safety) v ACKNOWLEDGEMENTS Jeff Haydu has been my primary advisor since I first entered the Sociology program at UCSD. My initial interest in the comparative-historical sociology of labor lined up very well with his work. For various reasons, however, I decided to embark on a contemporary project on US healthcare for my dissertation. I can’t say how much I appreciate Jeff’s dedicated mentorship. He has kindly and graciously helped me to overcome numerous professional challenges, and has always done so with practical assistance and good-natured humor. It is no exaggeration to say that I would not have completed this dissertation without Professor Haydu’s extensive support. My sincere thanks go out to my committee members – Andy Lakoff, Steve Epstein, Charlie Thorpe and Ed Hutchins. Andy Lakoff’s seminars – ‘Contemporary Theory,’ ‘Technology and the Human,’ and ‘Sociology of Risk’ – played a significant role in the theoretical perspective, derived from Foucault’s concepts, that guide this dissertation project. I have benefited greatly from Andy’s careful approach to teaching dense (and often convoluted) concepts like ‘governmentality.’ Steve Epstein’s meticulous scholarship, intersecting with such research fields as Science Studies and Medical Sociology, has provided an inspirational model to follow. This dissertation is still very far from attaining that model, but I aspire to Steve’s commitment with both his scholarship and his teaching. Charlie Thorpe was a late addition to the committee, and I am very grateful for his time and contribution to a student that he did not know so well beforehand. While the dissertation has taken quite a different direction from where it first began, I thank Ed Hutchins for his continuous support and interest in the project. vi Finally, in addition to my current committee members, I also wish to thank Michael Schudson for his initial service on my committee - for suggesting Ed as another member, and then for his continued interest in the project after he left UCSD. Besides my committee members, I’d also like to thank other members of the Sociology department who have helped me along in the program. Rick Biernacki supported my application, sold me on the program, and ultimately helped to guide me into Sociology at UCSD. John Skrentny has provided crucial support with my teaching in Law and Society Courses, a field of instruction that has become a major teaching interest of mine. I also thank John Evans, Isaac Martin and Kwai Ng for supporting my work through various venues (such as the Culture and Society Workshop). The staff at the Sociology Main Office has always been immensely helpful. Specifically for the trials and tribulations of a PhD student, the grad coordinators during my time – Rafael Acevedo for the first couple of years and then Manny dela Paz since then – have both been crucial allies. I especially extend my thanks to Manny for his help with navigating the pitfalls of advanced ‘ABD’ territory over the last couple of years. I’m thankful for the friends and colleagues, among the grad students in Sociology and in other programs, which I made at UCSD. I want to give very special thanks to Rob Fargo, Raquel Jacob-Almeida, Brian Lindseth and Kevin Moseby for their supportive company, so invaluable in so many ways, over the years. I am fortunate for a grad cohort of brilliant colleagues and good friends – my thanks to Michael Evans, Stephanie Chan, Gordon Chang, Tom Waidzunas, and Alper Yalcinkaya. Of course, grad school camaraderie spreads beyond ‘the cohort.’ At different times during my grad school career, I’ve benefited from knowing the likes of April Huff, Katie Kenny, Kris Kohler, vii Leslie Lewis, Martha Poon, Cindy Schairer, Jon Shafran, Matt Shindell, and Sabrina Strings. This list could go on – there’s not enough space to name all those that have been helpful in both personal and professional support over the years – so I thank all the kindred souls and fellow travelers that I was lucky to meet during my time at UCSD. Last but certainly not least, my sincere and humblest appreciation to my family. My thanks to my wife’s parents, Jean and David Hitchcock for first welcoming me in to their home as their son-in-law, and then for much-appreciated babysitting help. In addition, my thanks to Jean, for many leads in understanding healthcare organizations. My gratitude also extends to Bernie DeRuyter, who is no longer here to share in this accomplishment, but who helped me enormously when I was growing up. My brother, Adam, can also attest to the warmth of Bernie’s gentle and kind soul. His lasting imprint is apparent whenever Adam and I get together. To my mother, Mary Gagnon, for buying me that set of encyclopedias way back in grade school, which began an educational journey that has passed many years since I spent hours reading those volumes. Your hard work at the ‘Mill’ gave me an opportunity to pursue a love of learning - my deepest thanks for establishing the foundation for my lengthy educational goals. Without my daughter, Kora, this project would likely have already been completed. But from infancy through ‘terrible twos,’ I would not trade all that time spent on the playground and at the zoo for anything else. Finally, to my wife, Kathryn – we finally (almost) made it! I cannot fully express my gratitude for your love, support, and especially for your patience. While it’s been a bumpy ride at times, the destination, with this project as with anything else, would mean much, much less without you and Kora along for the journey. viii VITA 2001 B.A., Sociology, University of Wisconsin – Madison 2001-2003 Library Assistant, Social Sciences and Humanities Library, University of California, San Diego 2004, 2005 Research Assistant (for Professor Haydu and Professor Martin), Sociology Department, University of California, San Diego 2005 M.A., Sociology, University of California, San Diego 2004 – 2007 Teaching Assistant, Dimensions of Culture Writing Program, Marshall College, University of California, San Diego 2007 – 2009 Teaching Assistant & Associate-In, Sociology Department, University of California, San Diego 2008 – 2009 Senior Teaching Assistant, Sociology, University of California, San Diego 2009 – 2010 Teaching Assistant, Urban Studies and Planning Program, University of California, San Diego 2011 Associate-In, Sociology Department, University of California, San Diego 2011 Ph.D., Sociology, University of California, San Diego ix ABSTRACT OF THE DISSERTATION The Challenge of Patient Safety and the Remaking of American Medicine by Eric Van Rite Doctor of Philosophy in Sociology University of California, San Diego, 2011 Jeffrey Haydu, Chair This dissertation accounts for the ‘patient safety challenge,’ which developed over the course of 1990s, gained prominence in the early 2000s, and now occupies a significant place in healthcare reform. Positioning medical error as a significant, wide- ranging, and entrenched problem in need of attention, the patient safety challenge is a reform discourse. Patient safety reformers challenge the healthcare industry to take action to better manage medical error, and in so doing call for a major transformation in the structure of care delivery. x Charting major aspects of patient safety reform discourse, this dissertation addresses three overarching
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