Creating patient safety capacity in a nation's health system: A comparison between Israel and Canada

In 1966, the National Academy of Sciences published the report "Accidental Death and Disability: The Neglected Disease of Modern Society", [1] demonstrating that soldiers who were seriously wounded on the battlefields of Vietnam had a better survival rate than those individuals who were seriously injured in motor vehicle accidents on California freeways. The response in the U.S. was swift. The Paramedic, a new health care profession, was created; helicopters were introduced to facilitate timely transportation of injured patients to hospitals; and the Emergency Medical Services' response time was reduced. In Baltimore, Dr. R. Adams Cowley founded the Shock Trauma Center, a hospital dedicated to caring for trauma patients; many other trauma centers were established throughout the U.S.In the last decade of the 20th century, accumulating evidence and sentinel publications focused on adverse events and iatrogenic injury in health care. Anesthesiologists were the first to investigate the huge numbers of mishaps in anesthesia and establish a foundation for improving patient safety. The Australia Health Care Study, [2] "To Err is Human: Building a Safer Health System", [3] and "An Organization with a Memory" [4] revealed that large proportions of hospitalized patients in Australia, the U.S., and the U.K. have suffered an adverse event. A substantial proportion of the adverse events, many of them deemed preventable, resulted in death or severe injury.Following the publication of these reports, each of the involved countries established high profile committees with a mandate to examine the issue of patient safety and develop recommendations to address system deficiencies. These efforts have included strong support from federal and state governments. In addition, a variety of professional groups, employers, regulators, and healthcare providers have initiated a wide range of efforts to address this issue. Other countries have had a wide range of responses to the need for patien