The evidence is incontrovertible--we are inadvertently harming an unacceptable number of our patients by the very healthcare intended to help them. Most developed countries have responded to this evidence with substantial funding for dedicated patient-safety campaigns. New Zealand has a reasonable legislative foundation in relation to this problem but to date has not galvanised action at either the national or the organisational level. The reasons for this inaction are explored in this article and include a lack of understanding of the causes of medical error and of the difference between error and violation. Insistence on randomised controlled trial evidence and a business model is to misunderstand the constructs at stake and may inhibit the implementation of urgently needed safety strategies that are clearly sensible and worthwhile.
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