MR. O’NEILL: You know, I love what the Secretary said, and thank God for Don being here and Carolyn and for the work that Brent is doing. You know, so 2,500 institutions have signed up. I think our objective should be to do something that I did when I was at Alcoa and working on zero injuries to the workforce. In every institution, paint a wall white, and then ask every person who works there to sign their name under a pledge that says, “We will be perfect in everything we do.” Because until we have ownership by the people who do the work, we don’t have the ownership we need.

DR. FINEBERG: Paul, thank you very much. I wish we had time to continue this conversation and to engage more with our group here in question-and-answer. I have really enjoyed and benefited from this conversation. I’ve learned how precise we have to be with language, that some of the words we have used, like error and preventability, we have to rethink, because we need to cast in the positive goals rather than in the negativity and the false question of avoidability. I have learned that we need to make institutional excellence, habitual excellence, an absolutely central institutional attribute, that we can only very effectively, if we standardize systemically, a very important lesson, that the right culprit to focus on is system failure, that the right focus is on all causes, that zero is the right number, that everywhere is the right place, and that now is the right time. Please join me in thanking our panel.

Now, please join us for refreshments. We look forward to informal conversation.



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