Patient safety and health policy: a history and review

High-technologic industrialized medicine transformed the nature of disease and its treatment in the twentieth century, including heretofore “untreatable ” diseases such as chronic diseases and cancer. The evolution from an emphasis on vitamin deficiencies and infectious diseases to technologically driven chronic disease management has been accompanied by the rise of a cost-pressured and time-pressured highly distributed complex system. Risk and harm to patients from medical management itself has arguably become one of the biggest unintended consequences of this transformation. Preventable injuries to patients are beginning to be understood in terms similar to adverse events in other complex, risky industries that have learned to rely on the language of systems and causal analysis to create a foundation for continuous quality improvement and high reliability. The terms safety culture, near-miss reporting systems and event recovery, and human factors analyses are finding their way into the health care lexicon. Emergence of the patient-safety movement The safety movement in health care, however, can be described as being dormant for many decades, with explosive interest and growth beginning in the mid-1990s. Althoug