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sure units, accrediting bodies, and federal certification programs devote some attention to patient safety, but patient safety is not their sole focus. The National Patient Safety Foundation conducts educational programs, workshops, and various convening activities but its programs and resources are limited. The Food and Drug Administration (FDA) focuses only on drugs and devices through the regulation of manufacturers. The Joint Commission on Accreditation of Healthcare Organizations' (JCAHO) mission is to improve quality of care through accreditation. This may include issues relevant to patient safety, but patient safety is not its sole focus. Many states operate reporting programs or other oversight programs for patient safety but they take a variety of approaches and focus.

Although anesthesiology applied some of the techniques of system analysis and human factors during the 1980s, the concepts are just beginning to diffuse through the health care industry. The advantage of this lag is that we can learn about building safe systems from the experiences of others. The problem is that there has to be a substantially greater commitment to getting more and better information to advance the science and apply the techniques to health care.

The next section describes how attention to safety issues has been applied in two areas: aviation and occupational health. Both of these examples illustrate how broad-based safety improvements can be accomplished.

How Other Industries Have Become Safer

The risk of dying in a domestic jet flight between 1967 and 1976 was 1 in 2 million. By the 1990s, the risk had declined to 1 in 8 million.1 Between 1970 (when the Occupational Health and Safety Administration was created) and 1996, the workplace death rate was cut in half.2 Health care has much to learn from other industries about improving safety.

Aviation

Health care is decades behind other industries in terms of creating safer systems. Much of modern safety thinking grew out of military aviation.3 Until World War II, accidents were viewed primarily as individually caused and safety meant motivating people to "be safe." During the war, generals lost aircraft and pilots in stateside operations and came to realize that planning for safety was as important to the success of a mission as combat planning. System safety continued after the war when several military aviation



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