title: "Chance favors only the prepared mind": preparing minds to systematically reduce hazards in the testing process in primary care.
abstract: OBJECTIVE
  Testing plays a vital role in primary care. Failures in the process are common and can be harmful. As the great 19th century microbiologist Louis Pasteur put it "chance favors only the prepared mind." Our objective is to prepare minds in primary care practices to improve safety in the testing process. Various principles from safety science can be applied.
  
  
  METHODS
  A prospective methodology that uses an anonymous practice survey based on concepts from failure modes and effects analysis is proposed. Responses are used to rank perceived hazards in the testing process, leading to prioritization of areas for intervention. Secondary data analysis (using data from a study of medication safety) was used to explore the value of this approach in the context of assessing the testing process.
  
  
  RESULTS
  At 3 primary care practice sites, a total of 61 staff members completed 4 survey items examining the testing process. Comparison across practices shows that each has a distinct profile of hazards, which would lead each on a different path toward improvement.
  
  
  CONCLUSIONS
  The proposed approach treats each practice as a unique complex adaptive system aiming to help it thrive by inculcating trust, mutual respect, and collaboration. Implications for patient safety research and practice are discussed.
authors.affiliation: From the *UB Patient Safety Research Center, State University of New York at Buffalo, Buffalo, New York; †Department of Family Medicine, The Cleveland Clinic, Cleveland, Ohio; and ‡Department of Family and Preventive Medicine, University of Oklahoma, Norman, Oklahoma.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Singh
authors.forename: John
authors.initials: J
authors.lastname: Hickner
authors.forename: Jim
authors.initials: J
authors.lastname: Mold
authors.forename: Gurdev
authors.initials: G
authors.lastname: Singh
mesh_terms: D000328:Adult; D003073:Cognitive Dissonance; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019300:Medical Errors / Q000517:prevention & control*; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D061214:Patient Safety; D010824:Physicians' Offices / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011446:Prospective Studies