Proceedings of Enhancing Patient Safety and Reducing Errors in Health Care Vol. While it assumes that the reader has greater than average knowledge of how human error is facilitated and made more lethal by organizational flaws, most of the quoted speakers provide some scientific background for the topics that they discuss.
Medical care is itself a hazardous industry.
Patients endangered by illness causing hospitalization are exposed to hazards of surgery, medication, and radiation, then to the added risks of error and system failure. Certain principles may be guides to mishap prevention. K. H. Roberts compared programs that had disastrous failure with similar programs that did not. Several authors discuss blame as hazard. Anticipation of blame promotes cover up.