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Three Reasons Why Patient Safety Is Difficult to Improve

By: Paul Gallese

A new book written by Johns Hopkins University professor and a physician colleague sharply criticizes the patient safety movement for failing to deliver the improvements promised over two decades of research, funding and policymaking (Cruickshank, 2019).

Still Not Safe: Patient Safety and the Middle-Managing of American Medicine,” by professor Kathleen Sutcliffe and the late physician Robert L. Wears, points to two flaws in how patient safety has been studied since the 1999 publication of “To Err is Human: Building a Safer Health System” by the Institute of Medicine (now the National Academy of Medicine).

The first flaw is the absence of consensus about what is being studied, and the second is data collection methods the authors view as being subject to hindsight bias. The Vitalacy team’s experience observing patient safety initiatives in many hospitals is consistent with the book’s point of view, and we offer the following three reasons why patient safety improvement has been disappointing.


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