Americans are used to thinking about the many ways medical care can heal. The ways in which it can harm get less attention.
But those harms are very real. Medical errors kill more people than car crashes, breast cancer, AIDS, or drug overdoses. Depending on which estimate you use, medical errors are either the third or ninth leading cause of death in the United States.
When Sarah Kliff set out to explain the causes, prevalence, and consequences of medical errors, she took seriously the need to really, truly explain them. And she began from an often-neglected insight: Different audiences would respond to different kinds of explanations. So she would need to explain the problem from different vantage points, in different ways.
She began her project by trying to understand medical errors at every level — even as she worked with top experts and practitioners to understand the research on medical errors, she partnered with ProPublica to solicit stories of the ways medical errors have harmed individuals.
She then turned her reporting on the devastating but preventable toll taken by bedsores. The resulting piece manages to do something unusual: It’s a reported, longform explainer. It’s common, of course, for reporters to try to use a specific story to interest readers in a general phenomenon, but here, Kliff uses a general phenomenon to contextualize a specific story. Her explainer is an innovative, clear approach to the issue.
But there are people who want to know about medical errors — who need to know about them — who don’t want thousands of words of explanation. So Kliff worked with Vox’s video team to create a simple, even playful, video illuminating their impact. And then she took that video, broke it into its component images, and used it to create a visual explainer.
In her next piece, Kliff took on central line infections — and the devastating story of 3-year-old Nora Bostrom, who died from a possibly preventable infection.
Finding Nora was a challenge; it required combing through hundreds of stories that patients submitted through our ProPublica partnership. Understanding Nora’s story was also difficult. It required obtaining and analyzing more than 1,000 pages of medical records. Kliff worked with multiple doctors to ensure that her description of Nora’s condition, and her ultimate demise, was wholly accurate.
In this piece, Kliff uses Nora’s story to draw readers into the deeper question of how hospitals can prevent medical errors. During her reporting, she developed the powerful framing device of “car crash hospitals” and “plane crash hospitals,” and the result is an explanation not just of medical errors but of different kinds of organizational approaches to preventing costly mistakes.
Here, too, Kliff was cognizant of the fact that different kinds of readers needed different kinds of explanations. So she worked with video journalist Johnny Harris to turn her reporting into a powerful documentary on the Bostroms’ story, and she worked with data journalist Soo Oh to create an interactive feature where readers could find out how often central line infections happened at hospitals near them.
The story on central line infections focused on what happens to patients in the wake of tragic, medical errors. A complete explanation of the topic though, required looking at the providers who make these mistakes — and the anguish they feel in the wake of medical care gone wrong. Again, this required explanation from a different vantage point: the health care provider’s.
Kliff here focused on the story of Kim Hiatt, a nurse who committed suicide after her mistake killed a 9-month-old infant girl. This piece was another heavy, reporting lift. It required obtaining more than 750 pages of public records from Washington state agencies, a process that took five months to complete. Kliff spent time in Seattle interviewing Hiatt’s family, former co-workers and friends to create a complete portrait of how the nurse changed in the wake of her mistake.
The result is a humane, unique and morally-complex portrait of two deaths, Hiatt’s and her patients. The story explained why it matters that doctors and nurses are haunted by the ghosts of those they’ve hurt without minimizing the tragedies that occurred.
This last piece was designed with an online audience in mind. Kliff worked closely with Vox’s graphics editor, Javier Zarracina, to commission a simple set of cohesive illustrations — and also include many photographs of Hiatt — that helped pace readers through the longform story.
For this story, Kliff looked for new ways to increase the transparency of her reporting process. She worked with developers at DocumentCloud to create display for the public documents used to report the story that was easy for readers to explore themselves.
Taken together, this package explains the causes and costs of medical errors in more detail, and in more ways, than anyone has attempted before. It’s tremendous work, and we enthusiastically submit it for your consideration in the Explanatory Journalism category.