Recent reports in the United States and Canada have suggested that healthcare systems in both countries fall short in delivering high quality and safe patient care (Baker and Norton 2001; Institute of Medicine 1999, 2001). In addition to these reports, empirical studies have stressed the enormity of the problem of adverse events in hospitals in terms of frequency and severity (e.g., Evans et al. 1994; Budnitz et al. 2005; Classen et al. 2005). Investigators in the Harvard Medical Practice Study, for example, found that adverse events occurred in approximately 3.6% of hospitalizations in New York State (Brennan et al. 1991), the majority of which were due to drug complications (Leape et al. 1991). Such adverse events and errors have also been found to be preventable and significantly associated with longer hospital stays, disability and increased healthcare utilization and costs (Bates et al. 1997; Evans et al. 1993; Phillips, Christenfeld and Glynn 1998; Thomas et al. 1999; Classen et al. 2005). The United States incurs an estimated total (direct and indirect) cost of approximately $17 billion to $29 billion in preventable adverse events (Institute of Medicine 2001). Although some errors are attributable to poor performance by individual providers, the majority of preventable errors are a result of systemic and organizational deficiencies of healthcare delivery systems (Ball and Douglas 2002; Leape et al. 1998; Peth 2003).
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