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A Policy of System Safety: Shifting the Medical and Legal Paradigms to Effectively Address Error in Medicine

The vast majority of patient injuries are caused by human error by professional, caring persons acting in good faith. However, these humans are bound and constrained by systems in which they must act. Systems are the appropriate focus to address human factors and errors, rather than the traditional legal and medical paradigm of individually-oriented shame and blame, which is antithetical to system function and improvement. This paper reviews the basic of error, points to how the legal and medical systems represent prototypical shame and blame philosophies, and calls for a new systems-oriented ethical paradigm that expands individual accountability, substantively involves the patient, and focuses upon systems improvement, rather than ineffectual individual punishment, as its goal.