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First, Do Less Harm


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Table of Contents

Introduction 1. The Data Model That Nearly Killed Me 2. Too Mean to Clean: How We Forgot to Clean Our Hospitals 3. What Goes without Saying in Patient Safety 4. Health Care Information Technology to the Rescue 5. A Day in the Life of a Nurse 6. Excluded Actors in Patient Safety 7. Nursing as Patient Safety Net: Systems Issues and Future Directions 8. Physicians, Sleep Deprivation, and Safety 9. Sleep-deprived Nurses: Sleep and Schedule Challenges in Nursing 10. Wounds That Don't Heal: Nurses' Experience with Medication Errors 11. On Teams, Teamwork, and Team Intelligence Conclusion: Twenty-seven Paradoxes, Ironies, and Challenges of Patient Safety

About the Author

Ross Koppel is on the faculty of the Sociology Department and School of Medicine at the University of Pennsylvania, holds a faculty position at the RAND Corporation, and is the internal evaluator at Harvard Medical School as well as holding other professional affiliations. He is the author of several seminal publications on health IT in JAMA and other leading scientific journals. Suzanne Gordon is coeditor of the Cornell University Press series The Culture and Politics of Health Care Work and was program leader of the Robert Wood Johnson Foundation-funded Nurse Manager in Action Program. She is the author of Nursing against the Odds and The Battle for Veterans' Healthcare; coauthor of From Silence to Voice, Life Support, Safety in Numbers, Beyond the Checklist, and Bedside Manners; editor of When Chicken Soup Isn't Enough; and coeditor of The Complexities of Care, First, Do Less Harm, and Collaborative Caring, all from Cornell.


"Despite a decade of effort to decrease medical mistakes, progress has been painfully slow and unintended consequences have been the rule, not the exception. Two of the most innovative, iconoclastic thinkers in healthcare-Ross Koppel and Suzanne Gordon-have produced a book that tells us why, and illuminates the way forward. Their book is dramatic, honest, infuriating, surprising, and ultimately hopeful. It is a welcome contribution to the safety field, and deserves to be widely read."-Robert M. Wachter, MD, Professor and Associate Chairman, Dept. of Medicine, Chief, Division of Hospital Medicine, and Marc and Lynne Benioff Endowed Chair, University of California, San Francisco "The question of why we are unable to make the delivery of medical care safer and better-when we know how to do it-is a critically important but often neglected piece of the conversation on health reform. Although one reason for this failure is no doubt due to economic incentives, another is related to the archaic culture of health care. The essays in this book describe a system that is piecemeal, uncoordinated, dysfunctional, and dangerous for patients-and that doesn't have to be that way."-Mary Lehman MacDonald, Director, AFT Healthcare "First, Do Less Harm does an excellent job of detailing major system and cultural barriers confronting patient safety. Its authors discuss the important issues that we all face as frontline providers trying to deliver the best health care we can."-John Chuo, MD, MS, Children's Hospital of Philadelphia

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