Leape, Lucian

In a reply to McDonald and colleagues, Lucian Leape (2000) noted that some people seemed to have the impression that many of the deaths that had been attributed to adverse events were minor incidents in the care of people who were severely ill and likely to die anyway. He pointed out that terminally ill patients had been excluded from the study, but agreed that there were a small group of patients (14% of deaths attributed to adverse events) who had been severely ill for these patients the adverse event had tipped the balance. However, for the remaining 86%, the deficiencies in the care they received were a major factor leading to the death ... 

In his landmark paper on error in medicine, Lucian Leape (1994) argued that one of the most important reasons that clinicians have difficulty dealing with error is because of the culture of medical practice. He argued that physicians are socialized from the very first days of medical school to believe that errors are simply not acceptable. While error-free practice is a worthy ambition it is, of course, completely unattainable, so an internal conflict is inevitable ... 

Following the publication of the AHRQ report, Lucian Leape, Berwick and Bates (2002) wrote a powerful critique, in which they argued that the report had in various respects missed the point of patient safety. We will review their arguments, not to dismiss the undoubtedly useful report, but to highlight important issues about the nature of patient safety and the directions it should take in improving the safety of care. 

First, we make a general acknowledgment to major contributors to the field of patient safety whose work we have drawn on for this book. Among them are James Reason, Karl Weick, Jens Rasmussen, Richard Cook, David Woods, and Karlene Roberts. Special thanks to Lucian Leape for writing the Foreword he has been not only a pioneer in the field but also a mentor. Don Berwick, president of the Center for Healthcare Improvement, and Jim Conway, chief operating officer of the Dana-Farber Cancer Institute, both in Boston, have made substantial contributions through their work, which appears in this book. 

Don Berwick, Lucian Leape, Robert Wachter, Kaveh Shojania, and other physicians have campaigned unceasingly for years to improve patient safety. 

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