In the 6 years since the Institute of Medicine released its landmark report To Err Is Human,1 progress toward improving patient safety has been slow and arduous. Clinicians and researchers are struggling to advance the science of patient safety, understand its epidemiology, clarify priorities, implement scientifically sound yet feasible interventions, and develop measures to evaluate progress.
As errors have become more visible and patients continue to experience preventable harm, the public, regulators, accreditators, and clinicians have become frustrated. As frustration increases, so does the risk of implementing interventions without critically and independently evaluating whether they are effective or efficient. Surowiecki2 has described how crowds generally make correct decisions if the crowds are diverse and the decisions are independent. However, when decisions are not independent and the initial decision is incorrect, a negative information cascade may ensue and an incorrect decision may be widely implemented.
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