Errors must be accepted as evidence of systems flaws, not character flaws.”—Lucian Leape1 In losing Lucian Leape to heart ...

‘The Problem with…’ series covers controversial topics related to efforts to improve healthcare quality, including widely recommended but deceptively difficult strategies for improvement and pervasive ...

Correspondence to Ms Eileen Relihan, Medication Safety Office, Chief Executive Offices, St James's Hospital, James's Street, Dublin 8, Ireland; erelihan{at}stjames.ie Design and participants Pre- and ...

1 Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA 2 Center for Surgery and Public Health, Brigham and Women’s Hospital, Boston, Massachusetts, ...

Correspondence to: Dr Johan Thor Medical Management Centre, Berzelius väg 3, 5th floor, Karolinska Institutet, S-171 77 Stockholm, Sweden; johan.thor{at}ki.se Objective: To systematically review the ...

2 National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North West London (NWL), Imperial College London, London, UK Objectives ...

Violations are deliberate deviations from standard procedure. The usual reaction is to attempt to eliminate them and reprimand those concerned. However, the situation is not that simple. Firstly, ...

1 NHMRC Centre of Research Excellence in Patient Safety, Monash University, Melbourne, Australia 2 The Alfred Hospital, National Trauma Research Institute, Monash University, Melbourne, Australia ...

1 Professor of Health Policy and Management, The Nordic School of Public Health and The Karolinska Institute, Sweden, and The Faculty of Medicine, Bergen University, Norway 2 Robert Ratner Professor ...

Dual process theory (DPT) and the intertwined concepts of heuristics and biases, popularised by Kahneman's book Thinking Fast and Slow, are widely discussed models for analysing decision-making ...

Problem: Sliding scale insulin (SSI) is frequently used for inpatient management of hyperglycemia and is associated with a large number of medication errors and adverse events including hypoglycemia ...