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December 19, 2012

Prevention of Patient Harm—Reply

Author Affiliations

Letters Section Editor: Jody W. Zylke, MD, Senior Editor.

Author Affiliations: Johns Hopkins' Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland (Dr Pronovost;; and Patient Care Program, Gordon and Betty Moore Foundation; Palo Alto, California (Dr Bo-Linn).

JAMA. 2012;308(23):2458-2459. doi:10.1001/jama.2012.68802

In Reply: We agree with Dr Starr and colleagues that health care must take a systems approach that also includes organizational social systems to reduce harm. Health care occurs within organizations delivered by diverse people and teams who are influenced by powerful social norms, incentives, and culture. Our work draws upon these important theories and methods.1,2 Yet health care is not a pure organizational social system. It is a sociotechnical system in which patients, families, and staff interact and use an ever-expanding number of technologies, many of which are poorly designed and do not serve patients or clinicians well.

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