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December 14, 2005

Creating a Safer Health Care System: Finding the Constraint

Author Affiliations

Author Affiliations: Department of Medicine (Drs Pauker and Salem) and Office of the President (Ms Zane), Tufts–New England Medical Center, Boston, Mass.

JAMA. 2005;294(22):2906-2908. doi:10.1001/jama.294.22.2906

Primum non nocere. In Epidemics,1 Hippocrates urged all physicians to provide safe and effective care. Of course, that is not always possible because adverse events or bad outcomes sometimes occur. But physicians are driven to minimize the likelihood of harm, especially adverse events that more careful reasoning, better practices, and better systems might prevent. The Institute of Medicine called attention to the ubiquitous nature of errors in medicine and issued the challenge to develop safer systems of care.2-4 Safety, the flip side of doing the right thing at the right time, means not doing the wrong thing at any time, especially if the wrong action occurs inadvertently—by mistake—because the clinician or the system did not prevent an error before its effect reached a patient and caused harm.

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