The third-leading cause of death in the United States is medical error.

An analysis released on Tuesday shows that medical errors rank third in the United States after cancer and heart disease, accounting for at least 250,000 deaths annually. The analysis also shows that efforts to improve patient safety are woefully inadequate. “People die not just from heart attacks and bacteria, but from system-wide failings and poorly coordinated care,” explains Dr. Martin Makary, lead author of the study and a professor of surgery and health policy at Johns Hopkins University School of Medicine.