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Ensure leaders establish and sustain a safety culture

Create centralized and coordinated oversight for patient safety

Create a common set of safety metrics of meaningful outcomes

Increase research funding to examine patient safety and improvement science

Address safety across the entire care continuum

Support the health care workforce

Partner with patients and families for safest care

Ensure safe technology used optimally to improve patient safety

The global report used the same STEEEP model first developed for the 2001 IOM Crossing the Quality Chasm report, but made modifications reflecting new perspectives on equity, equality, social determinants of health, and access to health care (Figure 1.1).

Systems are hampered by a lack of technology that could drive some improvements, payers and providers are not in alignment, and few resources are allocated for coordinating care for complex conditions. Systems are largely designed for failure, with safety a reactive approach that regulates behavior and inhibits variability, with little effort paid to analyzing system issues.

Quality and safety are dependent on the culture, norms, expectations, and learning environment of systems—that is, hardwired into the organizational mission and vision. To improve, every level of a health care system must be examined to learn how each microsystem interacts within the larger system: how the environment, the organization, workers, and the patient at the center work in synergy (Neuhaus, Lutnæs, and Bergström, 2020). To improve, health professions education should be transformed with a guiding framework based on developing systems thinking for all providers to share in quality and safety improvements.