Growing up, filmmaker Mike Eisenberg didn’t know much about his prominent father’s work.
He was only 17 when his father, John M. Eisenberg, M.D., a pioneer in the patient safety movement, died from a brain tumor.
“Over the years I would hear stories about his work. There was always a curiosity about that,” said Eisenberg, in an interview with FierceHealthcare.
That curiosity led him to his latest film project, a documentary that focuses on avoidable medical mistakes—estimated to be responsible for 444,000 deaths each year in the U.S., making it the third leading cause of death. He titled the film To Err is Human, named after the landmark Institute of Medicine report released two decades ago that shook the medical profession by highlighting how many people lost their lives to preventable errors.
The documentary was released on video on demand last week but has already been seen by many healthcare professionals in screenings at healthcare organizations and academic institutions. Eisenberg said he wants the film to be screened in every state as well as other countries to bring awareness to patient safety.
(Courtesy of Mike Eisenberg)
The film has been received positively by those in the healthcare industry and he is glad it has people talking about patient safety, he said. “Whenever people watch this film, they leave with a strong sense of action.”
Tracing a father’s footsteps
Although he doesn’t have a healthcare background, Eisenberg said he got interested in patient safety three years ago when there was talk about potentially defunding the Agency for Healthcare Research and Quality, where John Eisenberg was the director before his death in 2002. In that role, he earned a reputation as an international patient safety expert and worked to make changes to improve quality in the healthcare industry.
The National Quality Forum and The Joint Commission annually recognize individuals and organizations that improve patient safety and healthcare quality through the John M. Eisenberg Patient Safety and Quality Awards.
Mike Eisenberg decided to interview the people who had worked with his father and said he soon realized there was a bigger story to tell: The broader story of patient safety and what has changed in the last 15 to 20 years of trying to improve healthcare quality.
He hopes the film keeps patient safety in the national discussion.
The documentary tells the story of healthcare professionals working to increase patient safety and patients harmed by medical errors. It includes interviews with healthcare leaders, footage of real-world efforts leading to safer care and highlights one family's story.
Like patient safety leaders, Eisenberg said he recognizes that while the vast majority of healthcare providers want to do the right thing, systems and processes often fail them. Human beings will make mistakes, but the healthcare industry can’t allow doctors and other clinicians to make the same mistakes over and over again, he said, with systems that fail to pick up errors and allow bad things to happen.
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“I definitely do think progress has been made,” he said, but the patient safety movement has not led to massive overhauls of processes that could protect patients.
The need for more change
The film includes an interview with Sue Sheridan, whose life was touched twice by medical errors. Failure to perform a bilirubin test led to cerebral palsy in her infant son Cal and failure to communicate a pathology test led to delayed treatment for her late husband Pat, who died of cancer at the age of 45.
“He lost six months of treatment. We don’t know what that cost. He could still be alive or have lived longer,” Eisenberg said.
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The film also looks at the efforts to improve patient safety, such as a training program that teaches clinicians how to talk to patients after an error occurs, he said. It highlights a program at the University of Chicago in which clinicians must identify mistakes in a simulated patient room—from IV bags with the wrong patient name to latex gloves left bedside when the patient has a latex allergy.
It’s important that leaders in patient safety share their ideas with other hospitals, particularly smaller organizations which may have less money to spend on safety solutions, he said.
(Courtesy of film To Err is Human)
Eisenberg said he is always relieved when colleagues of John Eisenberg tell him that his father would be proud of his film. “I gave a lot of thought to whether he would approve of our approach. I think he would be happy that at least someone has continued the conversation,” he said.
And Eisenberg said he may not be done with his focus on healthcare. “We’ve been tinkering with the idea of a follow-up. And also, the idea of [a film about] clinician burnout, which is its own crisis,” he said.