Steven H. Woolf, MD, MPH
Acknowledgments: The author thanks Anton J. Kuzel, MD, MHPE; Alex Krist, MD; Richard M. Frankel, PhD; John D. Engel, PhD; Valerie J. Gilchrist, MD; Charles Vincent, PhD; and the anonymous reviewers for their helpful suggestions on this manuscript.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Steven H. Woolf, MD, MPH, Departments of Family Practice, Preventive Medicine, and Community Health, Virginia Commonwealth University, 3712 Charles Stewart Drive, Fairfax, VA 22033; e-mail, firstname.lastname@example.org.
Ensuring patient safety is essential for better health care, but preoccupation with niches of medicine, such as patient safety, can inadvertently compromise outcomes if it distracts from other problems that pose a greater threat to health. The greatest benefit for the population comes from a comprehensive view of population needs and making improvements in proportion with their potential effect on public health; anything less subjects an excess of people to morbidity and death. Patient safety, in context, is a subset of health problems affecting Americans. Safety is a subcategory of medical errors, which also includes mistakes in health promotion and chronic disease management that cost lives but do not affect “safety.” These errors are a subset of lapses in quality, which result not only from errors but also from systemic problems, such as lack of access, inequity, and flawed system designs. Lapses in quality are a subset of deficient caring, which encompasses gaps in therapeutics, respect, and compassion that are undetected by normative quality indicators. These larger problems arguably cost hundreds of thousands more lives than do lapses in safety, and the system redesigns to correct them should receive proportionately greater emphasis. Ensuring such rational prioritization requires policy and medical leaders to eschew parochialism and take a global perspective in gauging health problems. The public's well-being requires policymakers to view the system as a whole and consider the potential effect on overall population health when prioritizing care improvements and system redesigns.
Organizational framework for deficiencies in health care serviceCenter.Second circle.centerThird circle.firstsecond circlesFourth circle.centersecondthird circles
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Woolf SH. Patient Safety Is Not Enough: Targeting Quality Improvements To Optimize the Health of the Population. Ann Intern Med. 2004;140:33–36. doi: 10.7326/0003-4819-140-1-200401060-00009
Download citation file:
Published: Ann Intern Med. 2004;140(1):33-36.
Emergency Medicine, Healthcare Delivery and Policy, Prevention/Screening.
Copyright © 2018 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use