Serious cultural barriers exist in health care, which will hinder any meaningful progress toward the development of a safety and quality agenda in health systems. The United States has the most highly educated, best trained health care practitioners in the world. These practitioners live by the ethos, first do no harm . Rarely is an individual to blame when a patient is injured by a system designed to help and not harm. More commonly, after an accident, serious and preventable systemic flaws are discovered.
Culture plays a key role.
Decisions made by managers and practitioners in health systems can have serious implications on the safety and quality of care provided to patients. Many decisions are made unilaterally, which points to a clear flaw in the system. Among the many factors leading to the space shuttle Challenger accident, for example, poor mechanisms for communication between frontline engineers and managers was a major problem. There are numerous analogies that can be made in health systems. Given the increasing complexity of medical care, we still expect physicians to be responsible for every aspect of patient care.