Still Not Safe

The term "patient safety" rose to popularity in the late nineties, as the medical community -- in particular, physicians working in nonmedical and administrative capacities -- sought to raise awareness of the tens of thousands of deaths in the US attributed to medical errors each year. But what was causing these medical errors? And what made these accidents to rise to epidemic levels, seemingly overnight? Still Not Safe is the storyof the rise of the patient-safety movement -- and how an "epidemic" of medical errors was derived from a reality that didn't support such a characterization. Physician Robert Wears and organizational theoristKathleen Sutcliffe trace the origins of patient safety to the emergence of market trends that challenged the place of doctors in the larger medical ecosystem: the rise in medical litigation and physicians' aversion to risk; institutional changes in the organization and control of healthcare; and a bureaucratic movement to "rationalize" medical practice -- to make a hospital run like a factory. If these social factors challenged the place of practitioners, then thepatient-safety movement provided a means for readjustment. In spite of relatively constant rates of medical errors in the preceding decades, the "epidemic" was announced in 1999 with the publication of theInstitute of Medicine report To Err Is Human; the reforms that followed came to be dominated by the very professions it set out to reform. Weaving together narratives from medicine, psychology, philosophy, and human performance, Still Not Safe offers a counterpoint to the presiding, doctor-centric narrative of contemporary American medicine. It is certain to raise difficult, important questions around the state of our healthcare system -- and provide an openingnote for other challenging conversations.

“"Reading Still Not Safe is like talking with Wears and Sutcliffe as they share honest, and at times dark, truths of the patient safety movement, while instilling a desire to continue this vital work. Read the book and reflect on your role in improving the safety of patient care." -- Pascale Carayon, PhD, Procter & Gamble Bascom Professor in Total Quality, University of Wisconsin, Madison "This extraordinary book is guaranteed to transform your thinking, whether you are a healthcare professional, a social scientist, or an ordinary citizen wanting to understand how good intentions get subverted - and why simple solutions, however appealing, should be regarded with suspicion." -- Gary Klein, PhD, CEO, ShadowBox LLC "An incisive lament and reflection on the early promise and subsequent waning of patient safety. But also a hopeful vision of a return to safety science, a deeper understanding of clinical work, and the potential for safer healthcare. A wonderful gift." -- Charles Vincent, PhD, Director, Oxford Healthcare Improvement "This important and controversial book argues that the field of patient safety has stalled out because it has become insular, bureaucratic, and overly medicalized. Agree or disagree, Still Not Safe is an important contribution to the literature and will cause readers to look at the field of patient safety with a refreshing new perspective." -- Robert M. Wachter, MD, Professor and Chair, Department of Medicine, University of California, San Francisco; author of The Digital Doctor and Understanding Patient Safety”

"This quality book clearly demonstrates that, in order to solve a complex problem, one must look at it from multiple perspectives. It will take a number of combined initiatives to drive the change needed to move forward in the reduction of medical errors, as the field has been stagnant for over two decades with the ideas currently in place." -- Blair A Hebner, Doody's Reviews"Reading Still Not Safe is like talking with Wears and Sutcliffe as they share honest, and at times dark, truths of the patient safety movement, while instilling a desire to continue this vital work. Read the book and reflect on your role in improving the safety of patient care." -- Pascale Carayon, PhD, Procter & Gamble Bascom Professor in Total Quality, University of Wisconsin, Madison"This extraordinary book is guaranteed to transform your thinking, whether you are a healthcare professional, a social scientist, or an ordinary citizen wanting to understand how good intentions get subverted - and why simple solutions, however appealing, should be regarded with suspicion." -- Gary Klein, PhD, CEO, ShadowBox LLC"An incisive lament and reflection on the early promise and subsequent waning of patient safety. But also a hopeful vision of a return to safety science, a deeper understanding of clinical work, and the potential for safer healthcare. A wonderful gift." -- Charles Vincent, PhD, Director, Oxford Healthcare Improvement"This important and controversial book argues that the field of patient safety has stalled out because it has become insular, bureaucratic, and overly medicalized. Agree or disagree, Still Not Safe is an important contribution to the literature and will cause readers to look at the field of patient safety with a refreshing new perspective." -- Robert M. Wachter, MD, Professor and Chair, Department of Medicine, University of California, San Francisco;author of The Digital Doctor and Understanding Patient Safety"This quality book clearly demonstrates that, in order to solve a complex problem, one must look at it from multiple perspectives. It will take a number of combined initiatives to drive the change needed to move forward in the reduction of medical errors, as the field has been stagnant for over two decades with the ideas currently in place." -- Doody's Reviews

ROBERT L. WEARS, MD, (1947-2017) was Professor in the Department of Emergency Medicine at the University of Florida and Visiting Professor in the Clinical Safety Research Unit at Imperial College London. His research focused on technical work studies, joint cognitive systems, and understanding the nature of safety and resilience in complex socio-technical systems, including medicine and healthcare.KATHLEEN M. SUTCLIFFE, PhD, is Bloomberg Distinguished Professor at Johns Hopkins University with appointments in the Carey Business School, School of Medicine, and the Armstrong Institute for Patient Safety and Quality. Her interests lie in understanding how high-hazard organizations and systems manage for the unexpected and how they can be designed to be more reliable and resilient.

The term "patient safety" rose to popularity in the late nineties, as the medical community -- in particular, physicians working in nonmedical and administrative capacities -- sought to raise awareness of the tens of thousands of deaths in the US attributed to medical errors each year. But what was causing these medical errors? And what made these accidents to rise to epidemic levels, seemingly overnight? Still Not Safe is the storyof the rise of the patient-safety movement -- and how an "epidemic" of medical errors was derived from a reality that didn't support such a characterization. Physician Robert Wears and organizational theoristKathleen Sutcliffe trace the origins of patient safety to the emergence of market trends that challenged the place of doctors in the larger medical ecosystem: the rise in medical litigation and physicians' aversion to risk; institutional changes in the organization and control of healthcare; and a bureaucratic movement to "rationalize" medical practice -- to make a hospital run like a factory. If these social factors challenged the place of practitioners, then thepatient-safety movement provided a means for readjustment. In spite of relatively constant rates of medical errors in the preceding decades, the "epidemic" was announced in 1999 with the publication of theInstitute of Medicine report To Err Is Human; the reforms that followed came to be dominated by the very professions it set out to reform. Weaving together narratives from medicine, psychology, philosophy, and human performance, Still Not Safe offers a counterpoint to the presiding, doctor-centric narrative of contemporary American medicine. It is certain to raise difficult, important questions around the state of our healthcare system -- and provide an openingnote for other challenging conversations.

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