Summary: To make real progress in patient safety will require redesigning the underlying system of care such that healthcare professionals and institutions providing a continuum of services from prevention to hospice can address multiple conditions and episodes over time. Competing priorities, professional autonomy, solo and small physican practices, disciplinary silos, mis-aligned financial incentives, and inadequate feedback about performance all undermine efforts to create safe healthcare systems. A number of strategic, cultural, techncial, and strucural barriers need to be addressed to assure safer care.
