In one way or another, the writers who contributed to this issue of QMHC addressed patient safety and protection as components of the quality of care. In the interest of medication safety, Monica M. Horwath, Heidi Cozart, Andrea Long, Julie Whitehurst, and their co-authors report on the design and impact of a trigger alert and review surveillance system in a three-hospital pharmacy setting. The authors explore the challenges that were implicit in bringing this complex system to sustainability, and they offer some concrete advice derived from experience.

Issues of public safety associated with patient follow-up and productivity in the process of diagnosing a communicable disease prompted the study reported by Herschel Knapp, Henry D. Anaya, and Matthew B. Goetz. The authors describe and evaluate the implementation of nurse-administered HIV rapid testing in place of more cumbersome and time-consuming procedures in a Veterans Administration primary care setting. Measuring the degree of harm resulting from medical errors was the objective of the project reported by Alok Madan, Deza Borckardt, Jeffrey J. Borckardt, Joan Herbert, and Harriet Cooney. Building on the University HealthSystem Consortium (UHC) Patient Safety Net (PSN) questionnaire, the investigators developed a system for rating and quantifying the harmfulness of events occurring in each of the UHC harm score categories.

The problem of managing risk in the presence of increasingly complex technology in health care is addressed by Uwe Wagner. Wagner argues that, if the end users of medical devices fail to acknowledge and report device-related incidents resulting in harm, they deprive device manufacturers of valuable data that could be used in improving product safety. He advocates for the development of an "error culture" characterized by a willingness to recognize, report, and analyze the occurrence of human errors resulting in injury to patients. A universally adopted critical incident reporting system (CIRS) would be integral to this initiative.

Can the implementation of Lean and Six Sigma be accomplished on a sustained basis and without compromising the quality of health care#x003F; Two authors address these issues. A detailed and insightful account of the early implementation of Six Sigma at a Veterans Administration tertiary hospital is provided by Christine Pocha. One of her conclusions is that what she calls the industrialization of health care in the interest of productivity and cost containment need not compromise the quality of care. Bozena Poksinska sets out, through a literature review, to provide some light on the current state of Lean implementation in health care. Among her findings is that Lean is currently used most often in implementing process changes.

Pavani Rangachari, Peter Rissing, Peggy Wagner, Karl Rethemeyer, and their co-authors have been studying the impact of organizational communication structures, whether "top down" or "peer to peer", on patient safety and clinical outcomes.1 In the present baseline study utilizing as an example hospital-acquired infection rates and communication events as reported by the surveyed clinical and administrative participants, the authors address the numerous and complex issues involved in identifying, measuring, and analyzing the association between communication structures and the rates of hospital-acquired infections.

Seven hospitals participated in the Pursuing Perfection (P2) Program, established with the goal of raising their quality improvement achievements to new levels of excellence. Michael Schwartz, Irene E. Cramer, Sally K. Holmes, Alan B. Cohen, and their co-authors surveyed employees of the participating hospitals to assess their perceptions of patient care quality and improvement progress, and to examine perceived performance on the dimensions commonly associated with high quality.

-Jean Gayton Carroll, PhD

Editor

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