Five System Barriers to Achieving Ultrasafe Health Care

René Amalberti, MD, PhD; Yves Auroy, MD; Don Berwick, MD, MPP; and Paul Barach, MD, MPH

Ann Intern Med. 2005;142(9):756-764. doi:10.7326/0003-4819-142-9-200505030-00012

Key Summary Points

In health care, the premium placed on autonomy, the drive for productivity, and the economics of the system may lead to severe safety constraints and adverse medical events.

Several key building blocks must be addressed before other solutions to the problem of unsafe medical care can be considered. Among these building blocks are the need to control maximum production, use of the equivalent actor principle, and the need for standardization of practices.

Safety in health care depends more on dynamic harmony among actors than on reaching an optimum level of excellence at each separate organizational level.

Open dialogue and explicit team training among health care professionals are key factors in establishing a shared culture of safety in health care.

The notion of a 2-tiered system of medicine may evolve logically by distinguishing between health care sectors in which ultrasafety is achievable and sectors that are characterized by ambition, audacity, and aggressive efforts to rescue patients, in which greater risk is inherent in the goals.

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