In the wrong hands, spearheaded by the wrong people with nefarious motives, zero tolerance efforts and policies can be abused and downright cutthroat and dangerous.

With no apologies to the Roman poet Ovid (circa 10 B.C.), the result (or end) does not justify the deed (or means).

Here in the healthcare battlefield, a growing number of provider and supplier organizations have been publicly proclaiming a variety of zero tolerance initiatives focusing on the prevention of medical errors that originate from clinical, financial or operational activities.

Their motives are noble. After all, who wouldn’t want to reduce medical errors, regardless of cause? There are clinical, financial – and even moral – implications at stake. Certainly, come October the Centers for Medicare & Medicaid Services no longer will tolerate them by eliminating reimbursement for procedures healthcare facilities perform to clean up after them. And private payers can’t be far behind in jumping on the reimbursement denial bandwagon either.

Some of the promotional slogans are quite clever. "Chasing Zero," created by a prominent distributor and manufacturer, probably tops the list. The fact that I can recall it so easily means it must be successful.

So what’s the problem?

From a financial or operational perspective, there shouldn’t be any. Make any mistake – intentionally or unintentionally – on a balance sheet, contract, purchase order, news report or speech, for example, and your accountability may range from a verbal or written reprimand, to a firing, to a lawsuit and to prison time, depending on the egregiousness or frequency of the errors.

From a clinical perspective, however, there’s a 50-50 split. Intentional errors – seeking to harm a patient or, in effect, an institution – must lead to serious consequences. Unintentional errors – arguably including such examples as not paying attention and not following established protocols (even if those protocols may be flawed) to save time – represent a vast gray area subject to finger pointing and human interpretation. Intentional errors can be controlled. By and large, most unintentional areas can be controlled, too. But not all. And therein lies the rub.

Clinical and legal minds have been debating for years what comprises a medical error. There’s a fiber-optic-sized line between a misdiagnosis and a missed diagnosis. Yet an undercurrent is rippling to make the latter just as evil as the former. Sometimes it can be. A doctor or nurse may overlook something for various reasons that can lead to an eventual fatality.

The X factor in all of this is our physiology. Each one of us is different from the other – our biological, chemical, emotional, mental, physical and spiritual composition. Each reacts differently to a drug, material in a scalpel, material in gloves, the trauma of being cut open on a surgical table, air particles floating around a room or from a person’s nose and mouth, skin cells constantly being ejected from our bodies, etc.

Clinicians do not – never did and never will – have total control over any of this, which is what contributes a lot of the guesswork in doctoring. It’s also why clinical – or critical – pathways, largely derided in the medical community as "cookbook medicine" failed. On paper, the concept made logical sense. But these best-laid plans were always hampered by deviations and variances largely because doctors had limited control over individual patient physiology (see, they’re not gods after all) and reactions, often having to react themselves. So they had to rely on judgment. Roll the dice.

In this finitely defined area, which realistically accounts for the vast majority of reported and unreported medical errors, zero tolerance represents a noble and noteworthy goal but one that is virtually impossible to achieve. We need to keep that in mind lest we do more harm than good as we strive to do more good than harm.