"Never events" - what are they?

"Never events" - what are they?

The term "never event" is being bandied around a lot at the moment it seems. Whenever technical terms like "never events" are taken by the wider community, they tend to be misused and abused by a process of appropriation for situations that are outside the initial ambit. In essence, they are used to label something by analogy, often as part of a moral panic.  

Apparently "whistle blowing" should be a never event. Or at least "true whistle blowing". This betrays a lack of understanding of what a "never event" is. The origin of never events is the billing system in the United States. If healthcare providers are funded for the treatment of the results of negligent care, then there is a perverse disincentive to preventing these complications, such as pressure ulcers. Further, never events are generally considered wholly preventable by an appropriate system for care. Their occurrence is prima facie evidence for either a failure to provide such a system, or the culpable failure of an individual to comply with that system. An example of this is operating on the wrong site (usually on the wrong side), or giving a blood transfusion to the wrong patient. Here the issue is more clearly patient safety than billing issues.

This is by contrast to other causes of harm such as delayed diagnosis or misdiagnosis, which may not be attributable to any fault as such, and are certainly not always amenable to elimination by better systems design. 

The attempt to appropriate the "never event" for these totally unrelated issues is at best sloppy, at worst a deliberate fudge.