The two most common causes of death in the United States are medical: heart disease and cancer, respectively. According to a new study, the third cause could also be medical—in a terrifying way. According to research published in the British Medical Journal, medical errors in hospitals and other medical facilities could be the third leading cause of death in the U.S., claiming 250,000 lives every year. One of the study’s authors wrote, “it boils down to people dying from the care that they receive, rather than the disease for which they are seeking care.”

According to Dr. Don Berwick, this revelation is actually nothing new.

Berwick co-authored a landmark paperon medical errors, published in 1999. “The news, in a way, is that this is treated as news,” Berwick said in an interview with Boston Public Radio Thursday. “This burden we bear of consequences of errors and injuries in healthcare has now been known for well over 20 years, and carefully documented… actually there’s almost nothing new in this paper, and it’s a little bit perplexing why the public is so unaware of this.”

According to Berwick, this news shouldn’t come as a shock, because of the inherent nature of human error. “What goes on is that doctors are human beings, so are nurses, and just like I mix up the names of my daughters and hit the wrong button on the radio sometimes, the same kind of human frailties exist in healthcare delivery,” he said. “The systems of care are very, very complicated.”

As humans, Berwick says, we’ve found ways to work around our fumbling in certain industries, using engineering processes of work to protect people from themselves. “We know how to design around human factors,” he said, “but in healthcare, because of the way [it] was designed and developed, we haven’t really done that very much. We still rely on heroism and personal commitment, and frankly, heroism doesn’t get you safety.”

The issue is not with individual medical professionals, but with the general culture, Berwick said. “Most doctors and nurses are just trying hard all the time to do the right thing,” he said. “That said, the cultural change we need is to move toward more openness and disclosure—and that probably, by the way, implies some changes in the malpractice environment, because when you’re constantly scared you’re going to be sued or attacked because of a mistake, you get scared and you run and you hide a bit.”

“We have to acknowledge, these are terrible tragedies,” Berwick said. “To get injured or killed by the care that was supposed to help you is awful, the suffering is immense and the numbers are staggering. But the right question isn’t then who to blame, the right question is what to do.”

So what can we do?

“One thing we know is blame and fear are inconsistent with safety,” Berwick said. “[If] you make a workforce scared, doctors, nurses, managers… they won’t get safe. Safety emerges in a culture of trust, openness, forgiveness, inquiry and commitment. A lot of it is top-down. When a leader knows how to make things safe… they can do things to really help the workforce do the right thing. The right thing is not to blame people.”

Dr. Don Berwick is President Emeritus and Senior Fellow at the Institute for Healthcare Improvement in Cambridge and former administrator at the Centers for Medicare and Medicaid Services (not to mention Massachusetts Gubernatorial candidate in 2013). To hear his full interview with Boston Public Radio, click on the audio link above.