Patient Safety Is Not Enough: Targeting Quality Improvements To Optimize the Health of the Population

Figure. . Lapses in patient safety—mistakes in the provision of health care that expose patients to “additive” risk—inducing risks for complications or overt injuries that did not exist before the clinical encounter (for example, amputating the wrong limb or prescribing a toxic drug dose). Medical errors—mistakes that encompass not only lapses in safety ( ) but that also include inattention to extant risks that patients bring to the encounter (for example, not offering pneumococcal vaccination or colorectal cancer screening to eligible patients or not achieving optimal blood pressure control). Lapses in quality—care that does not reach desired standards not only because of mistakes made by individuals ( and ) but also because of flaws in the design and operating procedures of systems and organizations (for example, failure to provide access to care, insurance coverage, timely reminders for overdue services, or acceptable waiting times). Lapses in caring—unsatisfactory care resulting not only from failure to meet normative benchmarks for quality ( , , and ) but also from experiences that leave patients feeling uncared for, affecting them in domains that are less easily measured (for example, feeling unheard, rushed, inconvenienced, or humiliated; or being unable to access desired information, instruction, or reassurance).
Figure. . Lapses in patient safety—mistakes in the provision of health care that expose patients to “additive” risk—inducing risks for complications or overt injuries that did not exist before the clinical encounter (for example, amputating the wrong limb or prescribing a toxic drug dose). Medical errors—mistakes that encompass not only lapses in safety ( ) but that also include inattention to extant risks that patients bring to the encounter (for example, not offering pneumococcal vaccination or colorectal cancer screening to eligible patients or not achieving optimal blood pressure control). Lapses in quality—care that does not reach desired standards not only because of mistakes made by individuals ( and ) but also because of flaws in the design and operating procedures of systems and organizations (for example, failure to provide access to care, insurance coverage, timely reminders for overdue services, or acceptable waiting times). Lapses in caring—unsatisfactory care resulting not only from failure to meet normative benchmarks for quality ( , , and ) but also from experiences that leave patients feeling uncared for, affecting them in domains that are less easily measured (for example, feeling unheard, rushed, inconvenienced, or humiliated; or being unable to access desired information, instruction, or reassurance). Organizational framework for deficiencies in health care serviceCenter.Second circle.centerThird circle.firstsecond circlesFourth circle.centersecondthird circles

This Article

  1. Ann Intern Med January 6, 2004 vol. 140 no. 1 33-36
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