• Bristol Inquiry
• patient-caregiver communication
• teamwork

The historical summary of risk management by Kuhn and Youngberg¹ in this issue of QSHC concludes with the provocative challenge: “Those risk managers who accept change and think of new ways to embed risk management principles into their organization to help create meaningful and sustainable change will prosper. Those who don't should get out now. They are destined to fail and to fail their organizations.”

This judgment may be a bit premature, too focused on the individual risk manager, and actually reverse cause and effect—that is, rather than “a need for risk management to evolve to assure a culture of safety”, perhaps the opposite is true. Is it possible that a culture of safety (high reliability) is the necessary prerequisite for allowing risk management to evolve? It is possible that, in a highly reliable safety culture, the risk management function as outlined by Kuhn and Youngberg may turn out to have minimal …