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August 14, 2002

How Best to Improve Patient Safety?—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;288(6):697-698. doi:10.1001/jama.288.6.693

In Reply: We did not aim to attack the IOM report, and we view it as an energizing boost to improving care. We do disagree with some of the details of their definitions. The IOM defined error as either a wrong plan, or as a poor execution of a correct plan. This definition is helpful in clarifying the distinction between adverse event/injury and error. However, it is still far removed from what we conceptualize as error. We feel that a poor decision or process reflects a failure of underlying, systematic causes. We believe that if systems are at fault and are the cause of poor decisions or processes, then error resides in the system rather than in failed individual decisions or processes of care.

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