• Quality and Safety in Health Care
• shame
• Quality and Safety in Health Care
• quality improvement

This issue of QHC marks its 10th anniversary—and the start of significant changes to the journal. QHC has become QSHC—Quality and Safety in Health Care. Safety is not a new topic for this journal. In the past we have included many papers relevant to risk management and the safety of health care. By adding “safety” to the title we acknowledge the growing realisation that healthcare systems too often harm the people who depend on them.

Finding ways to limit and stop the unnecessary and preventable discomfort, disability, and death directly attributable to the system of health care is a matter of urgent concern. Regular examples of such harm appear frequently in the world's newspapers.^1,2 In this issue Millenson³ charts the news media's influence on exposing the extent of the damage caused by health care and the importance of telling the truth to the public. Past tragedies cannot be reversed. We owe it to those who have been harmed and to future patients to work hard to understand what went wrong and how to make care safer. Liang⁴ reminds us, too, that honesty and disclosure to patients of all data about their care is the right policy.

Our change in title is an explicit signal of our intent to include papers that report research, ideas, and practical improvements relevant to the delivery of safer care. The distinction between quality and safety is partly a matter of semantics.

Care cannot be considered to be of high quality unless it is safe, and many of the topics considered in papers in QSHC such as team work, human factors, leadership, experiential learning and simulation, and organisational behaviour and change are relevant to all aspects of quality improvement—including safety. In this issue Carroll and Edmondson⁵ help us to understand that organisations need to be flexible, highly reliable, and willing to learn to capture complexity, and Mohr and Batalden⁶ remind us that all care is delivered through microsystems and that focusing on the system and the culture of care is crucial if healthcare delivery is to improve. We will continue to publish papers about the range of research relevant to developing and sustaining better and safer care. The next issue will include the first papers in a series that explores quality improvement research. Papers that describe the translation of research into practice are also important, as these may help to bridge the gap between what is known and what actually happens in routine practice.

Our transformation will include a new cover, layout, and—behind the scenes—the introduction of an electronic manuscript tracking system (see 5) which should speed the manuscript review process. The image on the cover will change each issue and be linked to a story (107). In this issue the cover illustrates a systems solution to the tragedies caused by “drug swaps”—drawing up and giving the wrong drug—which even a few weeks ago caused the death of a 51 year old firefighter, father of three, in Hammond, Indiana.² Adam Scheffler introduces an international scan of electronic information and resources about the quality and safety of care (pp 101–2) which will accompany Tom Smith's journal scan (pp 98–100). Steve Small introduces a series about those heroes and martyrs of quality who have understood the problems with the quality and safety of care long before the majority (103). Our first hero, Ernest Codman, proposed over 70 years ago that all surgeons should collect and report their operative outcomes—an idea we are still finding difficult (104). And, at the end of the journal, we have introduced “Action Points”, short summaries where we pose questions addressed by some of the papers in the issue and draw out possible actions that might help readers create change (108).

QSHC is available on line as well as in a paper version. This allows easy access to papers in current and past issues of QSHC and QHC with links through to Medline for papers referred to in articles. QSHC online will be free for the next 4 months to enable the widest possible audience to access this valuable resource. We hope it will become an indispensable source of reliable information.

Although many people access the web version of the journal, in the 18 months since going on line only two people have posted electronic responses to the articles we have published. We'd like to change that and encourage more feedback from our readers. We want to exploit the enormous capacity and flexibility provided by online access by offering background material on quality and safety of care. Electronic submission and peer review of manuscripts, online publication, and links to other sources of information are just a start. In the future our website may include online publication ahead of print, online only publication, posting detailed datasets, guidelines, case studies that include quality improvement reports and near miss and adverse events, and pictures and video clips. For now we welcome readers' feedback and comments and hope that you will continue to send us papers on all aspects of quality and safety of health care (www.qualityhealthcare.com)