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Stephen M. Shortell, PhD, MBA, MPH; Sara J. Singer, PhD, MBA

JAMA. 2008;299(4):445-447.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Patient safety has been a priority in health care since Hippocrates admonished physicians to "first do no harm." Even so, the Institute of Medicine found in 2000 that approximately 98 000 patients die from preventable medical errors each year.¹ Recent US Centers for Disease Control and Prevention estimates project that 270 individuals die each day from hospital-acquired infections.² Despite substantial efforts and investments, widespread and substantial improvement is not evident.

The problem is not in knowing what to do. Techniques, tools, and some best practices are available, and many health care organizations are making efforts to apply them.³ The importance of creating a "culture of safety" has also been noted.⁴ This involves continuous vigilance or mindfulness, learning, and accountability.⁵ A greater emphasis on safety over productivity and on teamwork over individual autonomy, increased standardization and simplification, and the implementation of . . . [Full Text of this Article]

Culture of Systems Explained

Author Affiliations: University of California-Berkeley School of Public Health, Division of Health Policy and Management, Berkeley (Dr Shortell); and Harvard School of Public Health, Department of Health Policy and Management and Institute for Health Policy, Massachusetts General Hospital, Boston (Dr Singer).

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