In “Transforming Health Care: A Safety Imperative”,1 Leape et al highlight the slow progress towards safe healthcare (see page 424). They notice that efforts in the USA to improve healthcare have fallen short. They conclude that only a transformation of healthcare can deliver safer care and better health outcomes. They identify transforming concepts, all pertinent and familiar.

Minimising errors has been central to Australia-wide efforts to improve healthcare since 1995 when the Australian Health Care Study was published.2 In Australia, as elsewhere, there are many enclaves of excellent care; they are testimony to human resilience and enlightened healthcare workers. What is it about these safe healthcare professionals and why aren't their attributes universal? Have we focused on the right parts of healthcare in our attempts to make improvements? Have our efforts in Australia made a difference?

Improved healthcare can ultimately lead to a transformation in the way care is delivered. Take complaints. Independent health complaint commissions established by states and territories have transformed the way complaints are managed. Important lessons are identified and passed on. From 1985 to 2000, I was responsible for complaints about health services and healthcare professionals in New South Wales. Patient complaints were the first indicators of the extent of adverse events. During the 1980s, an adverse event experienced by a patient and later complained about was not taken seriously by the providers or hospital management. Patients or carers were commonly told that all care had been taken and that the harm suffered was due to their condition or a complication and not to any failure by providers or management. Observations by …