If you want to go far,go together: A guiding principle for learning from medical errors

Kohn LT Corrigan JM Donaldson MS (eds.) To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.

Donaldson L . An organisation with a memory. Clin Med (Lond) 2002; 2: 452–457.

Leape LL . Error in medicine. JAMA 1994; 272: 1851–1857.

Vincent C , et al. Why do people sue doctors? A study of patients and relatives taking legal action. Lancet 1994; 343: 609–613.

Leape LL Berwick DM . Five years after to err is human: what have we learned? JAMA 2005; 293: 2384–2390. — explicitly asks whether anything changed.

Wachter RM Pronovost PJ . Balancing “no blame” with accountability in patient safety. NEJM 2009; 361: 1401–1406.

AHA report finds hospitals continue to improve performance on key patient safety measures, outcomes. Chicago, Illinois: American Hospital Association; 2025. https://www.aha.org/news/headline/2025-12-04-aha-report-finds-hospitals-continue-improve-performance-key-patient-safety-measures-outcomes (Accessed May 25, 2026)

Bates DW Levine DM Salmasian H , et al. The safety of inpatient health care. N Engl J Med 2023; 388: 142–153.

Kwaan MR Studdert DM Zinner MJ , et al. Incidence, patterns, and prevention of wrong-site surgery. Arch Surg 2006; 141: 353–357.

Barach P Small SD . Reporting and preventing medical mishaps: lessons from nonmedical near miss reporting systems. Br Med J 2000; 320: 759–763.

Sari ABA Sheldon TA Cracknell A , et al. Sensitivity of routine system for reporting patient safety incidents in an NHS hospital: retrospective patient case note review. Br Med J. 2007;334:79–81. doi:10.1136/BMJ.39031.507153.AE

Classen DC Resar R Griffin F , et al. “Global trigger tool” shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff 2011; 30: 581–589.

Hospitals did not capture half of patient harm events, limiting information needed to make care safer . Washington, DC: US Department of Health and Human Services, Office of Inspector General; 2025. Report number: OEI-06-18-00401. https://oig.hhs.gov/reports/all/2025/hospitals-did-not-capture-half-of-patient-harm-events-limiting-information-needed-to-make-care-safer/ (Accessed May 25, 2026)

Tucker AL Edmondson AC . Why hospitals don't learn from failures: organizational and psychological dynamics that inhibit system change. Calif Manage Rev 2003; 45: 55–72.

Eisenberg JM Power EJ . Transforming insurance coverage into quality health care: voltage drops from potential to delivered quality. JAMA 2000; 284: 2100–2107. PMID: 11042759.

Kippenbrock T Emory J. Hospital safety ratings and error reporting by hospital Providers. J Patient Safe Risk Management 2026; 31: 147–152.

Ferorelli D Byongiorno L Mele F , et al. The reporting of clinical adverse events scale (I-RoCAES): validation and psychometric characteristics of the Italian version. J Patient Safe Risk Manage 2026; 31: 139–146.

Kane A Lounsbury O Stockwell D . Rethinking patient safety: Why is patient safety event identification so challenging in day-to-day operations? J Patient Safe Risk Manage 2026; 31: 124–127.

Kapur A Ghadlinge M Hazarika K , et al. Knowledge, attitude and practices of nurses regarding medication administration error reporting. J Patient Safe Risk Manage 2026; 31: 153–160.

Harrington C Gallagher TH Benjamin E , et al. Health system strategies to increase physician engagement in Communication and Resolution Programs. J Patient Safe Risk Manage 2026; 31: 119–123.

Sokol-Hessner L Steward MC Sharma R , et al. Programs for responding after patients are harmed by their healthcare: A Making Healthcare Safer IV rapid review. J Patient Safe Risk Manage 2026; 31: 128–138.

Berry P . Imagining and implementing a responsibility culture in healthcare. J Patient Safe Risk Manage 2026; 31: 113–118.

Macrae C . Why safety recommendations don’t (always) work: understanding the problems and exploring some solutions. J Patient Safe Risk Manage 2026; 31: 161–169.

Figueroa-Altmann A O’Connor T . Strategies for safety event dissemination: A local risk assessment method. J Patient Safe Risk Manage 2026; 31: 170–174.

Wu AW Lipshutz AK Pronovost PJ . Effectiveness and efficiency of root cause analysis in medicine. JAMA 2008; 299: 685–687.