High reliability versus high autonomy: Dryden, Murphy and patient safety.
Healthcare is not a high-reliability industry. The adverse event rate is on the order of 10(-2); industries such as aviation, nuclear power and railways achieve rates of 10(-5) or better. Increasing awareness of this contrast has made "patient safety" a major topic of concern. High reliability in other industries flows from a combination of "engineered safety," tight regulation ("high-level constraints") and the development of a "culture of safety" that recognizes error as a systemic rather than a personal failure. In medicine, achieving such a combination would involve abandoning deeply embedded and centuries-old traditions of individualism, clinical autonomy and personal responsibility. This will not happen. Watch instead for safety concerns to be diverted into activities that do not threaten core values.
Evans
Robert G
RG
Cardiff
Karen
K
Sheps
Sam
S