Anatomic Pathology Workload and Error

The Institute of Medicine defined medical error as the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.1 During the last 2 decades, the pathology patient safety literature mainly has focused on reporting the frequency of error, and this frequency depends on the detection method.2-6 Few anatomic pathology studies have focused on the performance of error root cause analysis or on redesigning pathology systems so that fewer errors occur. Determining the root cause of error is an important step in error prevention through system redesign.7 A problem in error reduction is that most errors are secondary to multiple causes and difficult to target with a single initiative. In other areas of medicine, excessive workload has been correlated with higher error frequencies, and these investigations have led to changes in how workforce is used. In this issue of the Journal, Renshaw and Gould8 report that pathologist workload was not a significant driver of pathology error. This editorial examines the findings of Renshaw and Gould8 in the perspective of the psychology of error and other studies examining workload and medical error.