How Denmark Dumped Medical Malpractice and Improved Patient Safety

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How Denmark Dumped Medical Malpractice and Improved Patient Safety

In the U.S., patients harmed during medical care have few avenues for redress. The Danes chose to forget about fault and focus on what’s fair.

by Olga Pierce and Marshall Allen
Dec. 31, 2015

COPENHAGEN — It was a distressingly close call. A patient had been sent home from the hospital with instructions to take a common medication at a dose that would have poisoned her.

When Dr. Ole Hamberg heard about the mistake, he decided to investigate.

Hamberg, the head liver specialist at Rigshospitalet, the Danish national hospital, soon found something troubling. The hospital’s electronic prescribing system was mistakenly prompting doctors to give the drug, methotrexate, for daily use when it is safely taken only once or twice a week.

Patients throughout Denmark were being poisoned, Hamberg learned, thanks to the medical error. At his hospital, Hamberg made sure prescribing protocols were fixed and doctors and patients were informed. The problem quickly abated.

Hamberg was able to rapidly see a dangerous pattern because of something that doesn’t exist in the United States: A comprehensive national program to compensate victims of patient harm — and to learn from them by collecting and analyzing the data their experiences provide.

Patients who’d been overdosed filed claims under the compensation program, which makes its data available to hospitals and researchers. “Of course I use this information in my department,” Hamberg said. “We discuss how we can avoid this injury the next time.”

The Danish system offers lessons for policymakers in the United States, where medical harm remains widespread and the mechanisms for addressing it are often cumbersome and adversarial. The Danes’ primary focus is on helping patients who have been hurt by the health care system. While the reams of data gathered from claims aren’t used to publicly rate doctors and hospitals, or to systematically search for bad actors, they can help flag providers who have repeat errors and may pose a risk.
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The U.S. system for compensating injured patients — medical malpractice lawsuits — effectively shuts out patients when the potential damages are small. Proving negligence, the usual standard for winning compensation, is difficult. There are scant incentives for doctors and hospitals to apologize, reveal details about what happened, or report errors that might unveil a pattern.

Denmark offers a radically different alternative, as do similar programs in other Scandinavian countries ...

Common to all these programs is a commitment to provide information and compensation to patients regardless of whether negligence is involved. That lowers the bar of entry for patients and doesn’t pit doctors against them, enabling providers to be open about what happened.
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If a patient believes negligence was involved, it can be reported to a parallel system for professional discipline.

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