California is full of bad actors

California is full of bad actors. But maybe I should tell you something you don't already know.

In case you missed it last week, California's Governor Schwarzenegger replaced most members of the State Nursing Board. This action followed an LA Times report detailing the board's inability to evaluate and rule on allegations of professional misconduct by registered nurses in a timely fashion. A day or two later, two California state senators announced they were crossing party lines to author legislation that would reform the state's Medical Peer Review process. Both actions were widely reported under headlines forecasting improvements in "patient safety."

These initiatives--and others focusing on the processes used to evaluate and re-evaluate professionals who may be "bad actors"--are indeed part of the fabric that protects the safety of patients. But equating occasional long reaches down a dark foxhole with "patient safety" is a huge disservice, a distraction almost, relative to what the science of patient safety really is and what it takes to get the job done.

Patient safety is really the science of reliability applied to healthcare: How does a system operationalize processes in order to achieve a stated goal? It's not "How to cure cancer?" but rather, "How do we ensure that a patient is not killed by an overdose of chemotherapy while undergoing treatment to be cured of cancer?"

Goals like these rely on competent individuals, but they are not achieved--in a reliable fashion--solely because of them. (Having a sober pilot does not guarantee a safe flight.) Measures that focus on individuals' performance and behavioral choices should not be equated with the full spectrum of activities needed to improve the reliability of healthcare.

As healthcare reform ramps up, patients and professionals should be looking for measures--and funding--to enhance patient safety that are wider than a foxhole and constructed in a way that allows existing tunnels to connect.