The $50 million initiative by the Department of Health and Human Services is funding 94 projects throughout the country. It represents the federal government's largest single investment to address patient deaths related to medical errors. Two of those grants, totaling $3.3 million, were awarded to the University and BJC. The one-year grants were provided by the Agency for Healthcare Research and Quality to fund the first phase of a multi-year effort.

Victoria Fraser, M.D.

Victoria Fraser, M.D., associate professor of medicine at the medical school and director of Infection Control at Barnes-Jewish Hospital, received $1.9 million to develop a system for identifying and reporting errors and communicating the problem to patients. Bradley Evanoff, M.D., the Richard and Elizabeth Henby Sutter Chair in Occupational and Environmental Medicine and assistant professor of medicine, was awarded $1.4 million to study factors such as fatigue, stress and organizational culture that can lead to errors.

"Americans presently have one of the safest, most sophisticated health-care systems in the world," Fraser said. "We are looking for ways to make this phenomenal and complex delivery system even safer."

The 13 hospitals in BJC HealthCare, which includes Barnes-Jewish Hospital, have several programs in place to maximize patient safety. But according to W. Claiborne Dunagan, M.D., vice president for quality and director of the Center for Healthcare Quality and Effectiveness with BJC, these new studies will go beyond current knowledge and have a broader scope than most patient-safety studies.

"These grants are an incredible boost to our patient-safety efforts," said Dunagan, who is a co-principal investigator on Fraser's grant. "We will be exchanging innovative patient-safety ideas with other centers around the country, accelerating our access to new information."

Bradley Evanoff, M.D.

The fundamental problem, according to Fraser, is that health-care delivery involves a complex interaction of many people who rely on written and verbal communication.

"There is great potential for miscommunication, misunderstanding and errors," Fraser said. "We plan to develop a system that has built-in checks and balances and incorporates technology that reduces the risk of human error."

To achieve that, Fraser's study will probe how health-care workers communicate about errors with one another and with patients. Her team will work with the University's School of Engineering & Applied Science, the Olin School of Business and the Program in Health Administration and will seek ideas from fields such as aviation safety and automotive safety. "We hope to learn from industries with special expertise in error identification and prevention and to apply some of their methods and programs to health-care," Fraser said.

Evanoff will lead a team of researchers examining how working conditions within a system or organization increase the possibility of errors and affect quality of care. He believes factors such as inadequate staffing or working while in pain due, for example, to lifting a patient, contribute to poor-quality care.

"Rather than lay blame, we must recognize that health-care professionals are educated, highly skilled people working to provide expert, compassionate care for patients," Evanoff said. "We want to learn what it is about their working environment that increases the possibility of errors."