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Implementing a national strategy for patient safety: lessons from the National Health Service in England
  1. R Q Lewis1,
  2. M Fletcher2
  1. 1Special Advisor, National Patient Safety Agency, UK and Visiting Fellow, King’s Fund, London, UK
  2. 2Assistant Director of Patient Safety, National Patient Safety Agency, London, UK
  1. Correspondence to:
 Dr R Q Lewis
 National Patient Safety Agency, 4–8 Maple Street, London W1T 5HD, UK;


Improving patient safety has become a core issue for many modern healthcare systems. However, knowledge of the best ways for government initiated efforts to improve patient safety is still evolving, although there is considerable commonality in the challenges faced by countries. Actions to improve patient safety must operate at multiple levels of the healthcare system simultaneously. Using the example of the NHS in England, this article highlights the importance of a strategic analysis of the policy process and the prevailing policy context in the design of the national patient safety strategy. The paper identifies a range of policy “levers” (forces for change) that can be used to support the implementation of the national safety initiative and, in particular, discusses the strengths and limitations of the “business case” approach that has attracted recent interest. The paper offers insights into the implementation of national patient safety goals that should provide learning for other countries.

  • patient safety
  • government policy
  • National Health Service

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  • Conflict of interests: Richard Lewis is a paid consultant to the National Patient Safety Agency. Martin Fletcher is an employee of the National Patient Safety Agency.