• Quality improvement
• Quality measurement
• Quality improvement methodologies

The viewpoint by Dekker and Leveson, ‘The systems approach to medicine: controversy and misconceptions’1 is, in large part, a rebuttal to an op-ed piece I wrote in the Los Angeles Times.2 Therefore, I wish to reply.

The systems approach in medicine has come to include a multiplicity of standardisation techniques to correct defects: checklists, protocols, rules and data collection routines. In practice, the systems approach is inseparable from these. It is exclusively the systems approach that has guided the medical profession in its efforts to improve the death and injury statistics since the publication of To Err …