Although debate continues over estimates of the amount of preventable medical harm that occurs in health care, there seems to be a consensus that health care is not as safe and reliable as it might be. It is often assumed that copying and adapting the success stories of nonmedical industries, such as civil aviation and nuclear power, will make medicine as safe as these industries. However, the solution is not that simple. This article explains why a benchmarking approach to safety in high-risk industries is needed to help translate lessons so that they are usable and long lasting in health care. The most important difference among industries lies not so much in the pertinent safety toolkit, which is similar for most industries, but in an industry's willingness to abandon historical and cultural precedents and beliefs that are linked to performance and autonomy, in a constant drive toward a culture of safety. Five successive systemic barriers currently prevent health care from becoming an ultrasafe industrial system: the need to limit the discretion of workers, the need to reduce worker autonomy, the need to make the transition from a craftsmanship mindset to that of equivalent actors, the need for system-level (senior leadership) arbitration to optimize safety strategies, and the need for simplification. Finally, health care must overcome 3 unique problems: a wide range of risk among medical specialties, difficulty in defining medical error, and various structural constraints (such as public demand, teaching role, and chronic shortage of staff). Without such a framework to guide development, ongoing efforts to improve safety by adopting the safety strategies of other industries may yield reduced dividends. Rapid progress is possible only if the health care industry is willing to address these structural constraints needed to overcome the 5 barriers to ultrasafe performance.

We articulate an intellectual history and a definition, description and model of patient safety. We define patient safety as a discipline in the health care professions that applies safety science methods toward the goal of achieving a trustworthy system of health care delivery. We also define patient safety as an attribute of health care systems that minimizes the incidence and impact of adverse events and maximizes recovery from such events. Our description includes: why the field of patient safety exists (the high prevalence of avoidable adverse events); its nature; its essential focus of action (the microsystem); how patient safety works (e.g., high-reliability design, use of safety sciences, methods for causing change, including cultural change); and who its practitioners are (i.e., all health care workers, patients and advocates). Our simple and overarching model identifies four domains of patient safety (recipients of care, providers, therapeutics and methods) and the elements that fall within the domains. Eleven of these elements are described in this paper.

We have known for some time that cancer treatment in the United Kingdom needs to improve. This report looks at an attempt to use the collaborative improvement model to enhance services. We made considerable progress in the first year, and the model is now being applied to other cancers and other medical areas.

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Every hospital leader must re-evaluate the strategy, structure, and function of their infection control and prevention services toward the following parameters: Zero HAIs must be the goal. Purchasers will no longer wait for hospital losses to act. Forces of harmonization are an unprecedented force. New-found hospitals' harmonized standards can move from "playing defense" to "playing offense" against HAIs. Leaders must ignite the passion of teams to make rhetoric a reality. Real stories about real people communicate through real caregiver values. The power trio of governance, administrative, and medical leaders must turn their potential energy into action. We have the "what" we need to aim for, the "how" to get the job done, and it is now about engaging the "who" to seize the opportunity. Embrace champions to lead the charge.

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In times of crisis, we look to our core values. [1][2][3] The COVID-19 pandemic highlighted the importance of marrying our values with value to focus on what really matters. 4 A recent report by the King's Fund 5 also reflects this position.This central thread of a prudent approach is to manage resources in a way that helps us to achieve the best possible outcomes for all. We know that when core professional values are not adhered to, then poor quality of practice and care can result. Reimagining our health and care systemContinuing our traditional medical model ('more of the same') and the associated workforce model will not achieve the promise of prudent healthcare.

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