Patient safety - how much is enough?

Hospitals are complex systems, largely dependent on human performance, so improving hospital safety is not simple. Every change must be implemented with an understanding of human factors engineering and safety science, and even good changes can create unexpected new hazards. Increased safety precautions reduce preventable adverse events but generally impose both direct costs (to implement the safety precautions) and hidden costs (in the form of delays, new errors, or lost opportunities elsewhere). Perfect safety is not always possible and near-perfect-safety may impose unacceptably high costs. The goal of minimizing the total cost of both accidents and accident-prevention requires information on both costs and effects of specific safety improvements. Such information is also needed to prioritize suggested safety improvements, when all cannot be implemented immediately. This evidence can best be produced using the economic evaluation loop, an iterative process involving routine, periodic, assessment of costs and effects, and targeted original research where initial estimates reveal uncertainty in key values.