• patient safety

“Patient safety” has become a prominent topic in the medical lexicon since the Institute of Medicine in 1999 released its landmark report “To Err Is Human”.¹ Much of the ensuing discussion surrounding an individual patient’s well being treats “safety” as though it were a palpable, concrete entity which somehow can be created by command, manufacture, or spontaneous generation. Alas, it is neither so simple nor so tangible, nor is it accomplished by “doing what we always do, but doing it better”. We must rethink the institutions and processes through which health care is offered.

If danger can be defined as the probability of incurring injury or death as a result of participating in, or being subjected to, a given activity or behavior, safety is the inverse—that is, the likelihood of emerging unharmed from the same behavior. In the first instance it is a relative term since life itself is a high risk phenomenon of finite duration. Life permits no absolute safety. By definition, patients are confronting some highlighted element of life’s background risk when they enter themselves into the healthcare web. Those who seek care do so with the hope that they can find relief, all the while assuming that, in so doing, they do not expose themselves to new danger. Creating the environment where this assumption is justified is the challenge for patient safety activists.

In many potentially …