Patient safety: where have we gone wrong?

It is pretty widely accepted that the patient safety movement has been a failure. The authors of this paper in the Annals of Internal Medicine cite a lot of reasons and conclude:

Good evidence exists that educating caregivers about safety science and improving safety culture is the foundation of improvement efforts. Of course, reliance on the line worker is a long-standing tenet of quality improvement across many industries. With the emerging evidence that safety is not improving and is too heterogeneous to be assessed by externally mandated measures, we conclude that external top-down efforts to measure safety should cease to expand. We should measure what matters by focusing on creating a positive safety culture, developing HIT tools to detect local safety problems, and training frontline caregivers to improve patient safety.