Patient and provider perspectives on safety as a focus of change

This chapter considers and contextualizes how patient safety rose to public prominence as an improvement priority. It builds upon the Institute of Medicine's six dimensions of quality care to note neglect of potentially uncomfortable tensions between enhancing safety and delivering other quality dimensions. A requirement for speedy action, insufficient knowledge, or a lack of patient capacity or willingness to engage in decision-making can place patient-centred decision-making and patient safety in conflict. The chapter focuses on patients' role in patient safety and on system and organizational attempts to create environments that reduce risk and enable learning and continuous improvement-oriented change. It has made clear that safety is not simply a technical matter, but also a focus of professional and organizational politics. The chapter has noted the difficulty of managing safety on existing and new care frontiers, together with patients, in ways that attain an appropriate balance between prevention and improvement.