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. Fear of criticism in close calls and near misses precludes rational analysis of possible injury precursor mechanisms, and thus of the opportunity for constructive accident prevention. Every safety and quality project, it is stressed, requires not only participation of senior medical and administrative management, but also leadership in command and control. That control includes evaluation of error and demands training, redundancy in facilities and in knowledgeable personnel, and formal rules and procedures for management of mishap when it does occur. Major concerns are reflected in the book.