Erosion of Peer Review and Quality Assurance Privilege

An organizational culture that values open discussion of potential problems, near misses, and errors without fear of retribution is crucial for safety science and culture. Examples such as the Andon cord at Toyota and the Challenger explosion highlight the importance of such a culture. In healthcare, the concept of tracking procedure outcomes for quality improvement has been introduced but not fully realized. Overall, promoting systems-based improvements in patient safety and healthcare quality requires open and nonpunitive discussion of errors and problems.