This year, the Fund-sponsored Colloquia on Quality Improvement, chaired by David Blumenthal, M.D., marked the fifth anniversary of the publication of To Err Is Human,⁽⁴⁾ the Institute of Medicine's landmark report. At an expert forum, members of the original IOM committee as well as leaders from the Joint Commission on Accreditation of Healthcare Organizations, National Patient Safety Foundation, and other key organizations reviewed evidence of progress in the past five years and made recommendations for next steps. Writing in the online edition of Health Affairs, Robert M. Wachter, M.D., one of the speakers, argued that despite some improvements in patient safety, considerable deficiencies still exist. In his patient safety "report card," he awarded the government's regulatory response the highest grade; the lowest scores went to the malpractice system and other vehicles for accountability.⁽⁵⁾

In an article published in the Journal of the American Medical Association, medical safety experts Lucian Leape, M.D., and Donald Berwick, M.D., made the case that To Err Is Human has made a profound impact on public attitudes as well as the actions of organizations—even though it has not yet resulted in comprehensive, nationwide improvements in safety.⁽⁶⁾ The authors say that the single most important strategy to achieve safety is to set "strict, ambitious, quantitative, and well-tracked national patient safety goals."

Medical and surgical procedures, once performed only in hospitals, now routinely take place in ambulatory care settings. Yet little is known about the quality and safety of care provided in doctors' offices and outpatient clinics. In the coming year, the Fund is supporting the Health Research and Educational Trust to conduct a survey of ambulatory care safety practices in collaboration with the Medical Group Management Association. This project will provide new data on the current state of safety in ambulatory care and identify areas in need of improvement.