title: Paying the piper: investing in infrastructure for patient safety.
abstract: BACKGROUND
  Although the best allocation of resources is unknown, there is general agreement that improvements in safety require an organization-level safety culture, in which leadership humbly acknowledges safety shortcomings and allocates resources at the patient care and unit levels to identify and mitigate risks. Since 2001, the Johns Hopkins Hospital has increased its investment in human capital at the patient care, unit/team, and organization levels to improve patient safety.
  An inadequate infrastructure, both technical and human, has prompted health care organizations to rely on nurses to help implement new safety programs and to enforce new policies because hospital leaders often have limited ability to disseminate or enforce such changes with the medical staff.
  At the team or nursing unit level, there is little or no infrastructure to develop, implement, and monitor safety projects. There is limited unit-level support for safety projects, and the resources that are allocated come from overtaxed department budgets.
  HOSPITAL LEVEL AND HEALTH SYSTEM: Infrastructure is needed to design, implement, and evaluate the following domains of work-measuring progress in patient safety, translating evidence into practice, identifying and mitigating hazards, improving culture and communication, and identifying an infrastructure in the organization for patient safety efforts.
  
  
  CONCLUSIONS
  Fulfilling a commitment to safe and high-quality care will not be possible without significant investment in patient safety infrastructure. Health care organizations will need to determine the cost-benefit ratio of various investments in patient safety. Yet, predicating safety efforts on the mistaken belief in a short-term return on investments will stall patient safety efforts.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Surgery, and Health Policy and Management, The Johns Hopkins University, Baltimore, USA. ppronovo@jhmi.edu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.forename: Beryl J
authors.initials: BJ
authors.lastname: Rosenstein
authors.forename: Lori
authors.initials: L
authors.lastname: Paine
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
authors.forename: Karen
authors.initials: K
authors.lastname: Haller
authors.forename: Richard
authors.initials: R
authors.lastname: Davis
authors.forename: Renee
authors.initials: R
authors.lastname: Demski
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Garrett
mesh_terms: D015142:Baltimore; D006785:Hospitals, University / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D019982:Organizational Case Studies; D015279:Organizational Culture; D017064:Process Assessment, Health Care; D017751:Safety Management