Chapter 55. Legislation, Accreditation, and Market-Driven and Other Approaches to Improving Patient Safety

Although conventional approaches to health care quality improvement based on educating providers and offering feedback have been proposed, the tremendous public and professional concerns raised by the Institute of Medicine’s report on medical errors have led to an unusual amount of interest in regulatory and legislative efforts to improve safety. Given the traditional American dependence on education, competition, and other non-coercive mechanisms of change, the shift toward a regulatory approach is evidence of the depth of concern this issue has engendered. As these regulatory and legislative approaches are considered, it is also worthwhile to consider the role of health care payers, hospital accreditation organizations, and professional societies, all of whom have also led safety initiatives. This chapter considers the potential advantages and disadvantages of legislative, regulatory, professional society, and market-oriented approaches to implementing patient safety efforts, and reviews the evidence regarding their effectiveness.