The Long Road to Patient Safety

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Abstract
The 1998 Institute of Medicine (IOM) National Roundtable on Health Care Quality and subsequent IOM reports ushered in a period of extensive research about the quality of the US health care system. The IOM reported that “serious and widespread problems occur in small and large communities alike, in all parts of the country, with approximately equal frequency in managed care and fee-for-service care.”1 In To Err Is Human, the IOM provided in-depth analyses of a wide range of patient safety problems and underscored the need for improvement.2 Subsequently, in Crossing the Quality Chasm, the IOM called for “fundamental change . . . to close the quality gap and save lives,” and proposed a national initiative to “provide a strategic direction for redesigning the health care system of the 21st century.”3,4 These documents indicate that successful implementation of change in the nation’s overall health care system requires change in specific patient safety systems at the hospital level.