My 20-something friend Colby observed recently that her younger brother unwittingly scares away girlfriends by jumping too quickly to the “define the relationship” conversation. I thought of Colby at a conference I attended in April, where the topic of changing roles for physicians and patients infused all proceedings. Rather than scaring people away, interest in “defining the relationship” packed the house.

John Smith is admitted late Monday afternoon to the post-surgical ward after a total knee replacement. John is overweight, though not morbidly obese, and has an undeclared history of snoring. He wakes up at 5:30 Tuesday morning with considerable pain; over the next hour he exhausts the opiate supply in his PCA pump, and his nurse inserts a new syringe before her shift ends at 7 a.m.

Talking about the hospitalized patient’s role in medication safety may suggest shifting responsibility away from the provider, but that is not my intent. This dialogue is intended to foster the development of approaches to care that lead to partnering with patients in care delivery and in sharing responsibility. A decade ago, a survey by the Canadian Institute for Health Information found that Canadians give high priority to enhanced information regarding health. Martin’s survey (2002) of patient views on the patient-provider relationship found that more than 50% of patients believe they have primary responsibility for decisions regarding their health; an additional 35.6% expect to share decision-making with their healthcare providers.

The surge of voluntary regional and national initiatives to improve patient safety demonstrates the momentum building to unite the healthcare community. Recently, the Institute for Healthcare Improvement’s 100,000 and 5 Million Lives Campaigns enrolled thousands of hospitals in a concerted effort targeting patient safety. Regionally, states such as Maryland have established networks to encourage peer-to-peer collaboration and learning. Now, the federal government has set the groundwork for a national network of organizations working to reduce harm to patients.

Historically, the medical community has accepted that a certain amount of unintended injury and error will occur because of the complex nature of medicine and variation in patients. The executive team of a large multi-state health system knew it had to change that mindset among leaders and healthcare providers in its 32 hospitals.

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Surgical procedures account for a major share of a typical hospital’s overall financial performance. It is estimated that surgical services and associated care often generate around 60% of a hospital’s total revenues and some 30% to 40% of a hospital’s total expenses. Yet even as clinical information systems evolve forward rapidly in many areas of hospital operations, the vast majority of hospital organizations still have not yet fully automated their surgery processes.

When sentinel events and near misses occur, the risk manager investigating the event often hears these types of statements from the people involved: “I didn’t mean to…,” “I thought you were…,” or often, “If only I could do it all over again…”

Philadelphia-area hospitals have charted a unique strategy in patient safety: Facilities that are normally competing for patients are collectively identifying effective measures to prevent patient falls. Harnessing their strength as a regional collaborative, the hospitals have shared stories of how to implement effective interventions for falls prevention and have participated in brainstorming workshops to identify a long list of additional strategies. The facilities can then choose from the list those interventions that zero in on their unique challenges.