Patient safety is a fundamental principle of health care. Understanding the causes of medical error and strategies to reduce harm is simple compared with the complexity of clinical practice. Communication breakdown remains a leading contributor to adverse events in the United States. Every point in the process of care-giving contains a certain degree of inherent unsafety. A number of countries have published studies showing that significant numbers of patients are harmed during health care, either resulting in permanent injury, increased length of stay in health care facilities, or even death. Clear policies, organizational leadership capacity, data to drive safety improvements, skilled health care professionals and effective involvement of patients in their care, are all needed to ensure sustainable and significant improvements in the safety of health care. The purpose of this document is to discuss strategic pathways to accelerate future improvement in patient safety. It includes fundamental changes in health care education, patient engagement, transparency, care coordination, and improving health care providers’ morale. Transforming groups of individual experts into expert teams is central to this cultural transformation. This document aims to address the weakness in health systems that lead to medication errors and severe harm that results. It lays out ways to improve the way medicines are prescribed, distributed, and increase awareness among patients about the risks associated with the improper use of medications. Both health workers and patients can make mistakes that result in severe harm, such as prescribing, ordering, dispensing, preparing, administrating or consuming the wrong medication or the wrong dose at the wrong time. But all medication errors are potentially avoidable. Preventing errors and the harm that results requires putting systems and procedures in place to ensure the right patient receives the right medication at the right dose at the right time. Although much progress has been made, there is still much work to be done to reduce iatrogenic harm. Key to future improvement is engaged clinical and organizational leadership that must drive a shift in culture and help transform individual experts into expert teams.

The stress resulting from a medical liability case can have a negative effect on physician’s personal and professional life, and their ability to defend themselves against the charge. The purpose of this document is to promote mental wellbeing of healthcare providers by the provision of productive and healthy workplaces. Wellness goes beyond merely the absence of distress and includes being challenged, thriving, and achieving success in various aspects of personal and professional life. When physicians are unwell, the performance of healthcare systems can be suboptimum. Physician wellness might not only benefit the individual physician, it could also be vital to the delivery of high-quality health care. This review discusses the work stresses faced by physicians, the barriers to attending to wellness, and the consequences of unwell physicians to the individual and to healthcare systems. There are many programs in the USA, Canada and UK that are designed to improve physician’s wellness by recognition of potential health problems and by the provision of education and support (e.g. from basics such as getting enough food at work, sleeping properly, and to how to deal with adverse events, complaints, and litigation). The endpoint is better care for patients and improved system outcomes. Individual physician wellness is a valid indicator for organizational health. Healthy physicians mean healthier patients, safer care, and a more sustainable workforce.

The greatest ongoing challenge for health care reform in the United States is to provide better health care for less money. Both aspirations are possible, but only if the nation is willing to overhaul the unreliable system of medical justice. Containing costs requires changing the rules for all participants. A range of malpractice reform proposals have been suggested as part of the national debate, and it is useful to examine them and identify the advantages of each. All of these reforms have significant merit, but special health courts are by far the most important in reducing defensive medicine. Perhaps the most important reason for adopting administrative compensation models for adverse medical outcomes is the effect on patient safety and quality of care. Adverse outcomes, preventable or otherwise, are an uncomfortable reality of medical care. Disclosure and discussion of adverse events in health care is desired by patients and championed by safety experts and policy makers.