We review what leaders of health care systems, including chief executive officers and board members, need to know to have "patient safety literacy" and do to make their systems safe. High reliability organizations produce reliable results that are not dependent on providers being perfect. Their characteristics include the commitment of leadership to safety as a system responsibility, with a culture of safety that decreases variability with standardized care and does not condone "at-risk behavior." A business case can be made for investing resources into systems that produce good outcomes reliably. Leaders must see patient safety problems as problems with their system, not with their employees. Leaders need to give providers information to make and monitor system progress. All medical errors, including near misses, and processes associated with all adverse events may provide information for system improvement. Improving systems should produce better long-term results than educating workers to be more careful.

This paper assesses the implications for policy of recent aggressive efforts by manufacturers to enforce price-confidentiality clauses in contracts with hospitals for purchases of physician preference items (PPIs) such as implantable medical devices. Secrecy clauses prevent hospitals from revealing prices to third parties that help them negotiate prices and to surgeons who specify which device brands and models hospitals purchase. Litigation focused the attention of journalists and policymakers on problems that result from the asymmetry of information between buyers and sellers in the market for PPIs. Legislation is pending.

Health technology forecasting is designed to provide reliable predictions about costs, utilization, diffusion, and other market realities before the technologies enter routine clinical use. In this article we address three questions central to forecasting's usefulness: Are early forecasts sufficiently accurate to help providers acquire the most promising technology and payers to set effective coverage policies? What variables contribute to inaccurate forecasts? How can forecasters manage the variables to improve accuracy? We analyzed forecasts published between 2007 and 2010 by the ECRI Institute on four technologies: single-room proton beam radiation therapy for various cancers; digital breast tomosynthesis imaging technology for breast cancer screening; transcatheter aortic valve replacement for serious heart valve disease; and minimally invasive robot-assisted surgery for various cancers. We then examined revised ECRI forecasts published in 2013 (digital breast tomosynthesis) and 2014 (the other three topics) to identify inaccuracies in the earlier forecasts and explore why they occurred. We found that five of twenty early predictions were inaccurate when compared with the updated forecasts. The inaccuracies pertained to two technologies that had more time-sensitive variables to consider. The case studies suggest that frequent revision of forecasts could improve accuracy, especially for complex technologies whose eventual use is governed by multiple interactive factors.

As developmental psychology "comes of age," there is increasing interest in tracing the history of thought and research concerning children (Lomax, Kagan, and Rosenkrantz 1978; Sears 1975; Senn 1975). Such an enterprise offers the possibility of providing not only a descriptive chronicle of personal or anecdotal interest, but a basis for insights into how our ideas have been shaped by the cultural context in which they were developed. It is, for instance, by now commonplace to note that much of Freud's thought should be seen in the context of 19th-century Vienna, and that many of his perceptions may have been correct for the individuals he observed although they may fail as immutable observations of human behavior in general (see, e.g., Mitchell 1974). The present paper explores the cultural and historical context of another major theorist of child development, John Bowlby. The early origins of Bowlby's theory are sought in events set in train in Britain by the First World War, and occurring during the interwar period. This may surprise readers who think of Bowlby's work as beginning with the WHO Report (Bowlby 1951) and consequently as related to the Second World War, to observations by Burlingham and Freud (1942, 1944) of children separated from their families, and to Spitz's (Spitz and Wolf 1946) work on infants in foundling homes and orphanages. But formulations in the WHO report clearly appear in Bowlby's work before World War II and are also evident in the writings of Klein (1935, 1940) and Suttie (1935), who were working on themes first drawn into focus during the first World War. In a personal interview, Bowlby identified 1929 as the time when he was first struck by the importance of separation in children's lives. Thus, this paper focuses on the effect of the "Great War" on psychoanalytic thought and, more generally, on psychiatry in Britain.

A National Patient Library, a public/private partnership, is proposed to identify and vet information for consumers. Library staff will help tailor general information to consumers' specific needs. The library includes an electronic network. The principal focus of the library's information is controversial and experimental procedures, pharmaceuticals, and medical devices.