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Looking back on the history of patient safety: an opportunity to reflect and ponder future challenges
  1. Gordon Schiff1,
  2. Kaveh G Shojania2
  1. 1General Medicine, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, USA
  2. 2Department of Medicine and the Centre for Quality Improvement and Patient Safety, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Gordon Schiff, General Medicine, Brigham and Women's Hospital Department of Medicine, Boston, MA 02120, USA; gschiff{at}

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The publication of To Err is Human1 by the US Institute of Medicine (IOM) helped launch not just the field of patient safety but the broader interest in healthcare quality. The report’s estimates of 44 000–98 000 annual deaths from medical error in US hospitals—eye-catchingly equated to a jumbo jet crashing every day and a half—captured headlines and widespread attention. The IOM (now the National Academy of Medicine, NAM) followed up this success with Crossing the Quality Chasm,2 which notably defined quality in terms of six distinct dimensions, including not just safety, but also effectiveness, patient centredness, efficiency, timeliness and equity.

Many might have feared that the interest generated by these two reports would represent passing fads rather than enduring fields. Thankfully, that has not occurred. Patient safety and broader quality improvement efforts remain active areas of research and operational activities in healthcare organisations around the world. In addition, some funding agencies focus on healthcare quality, as do an increasing number of journals, such as BMJ Quality and Safety, and many public interest advocacy groups have been spawned.

It thus feels fitting that a new book, Making Healthcare Safe: The Story of the Patient Safety Movement,3 should recount the birth and subsequent development of patient safety as a field. The author, Lucian Leape, played a leading role in launching the field—not just as one of the authors of To Err is Human, but also through numerous prior and subsequent contributions. Leape helped lead the seminal Harvard Medical Practice Study4—one of the two large studies that generated the widely quoted estimates of deaths due to medical error. A few years later, Leape’s groundbreaking article on Error in Medicine5 outlined many ideas that remain paradigmatic. Fast forward a quarter century and we now have this …

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  • Contributors Both authors contributed to writing and reviewing the final draft.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.