One of the most prominent efforts to promote a "total safety culture" in the area is the Pittsburgh Regional Healthcare Initiative, a consortium of hospitals, healthcare providers, insurers and civic and business leaders that aims to eradicate medical errors. Its goals are:

Zero medication errors.

Zero healthcare-acquired infections.

Perfect clinical outcomes, as measured by complications, readmissions and similar patient outcomes, in coronary artery bypass graft surgery; chronic conditions, such as depression and diabetes; obstetrical concerns from maternal health to child delivery; and orthopedic treatments, such as hip and knee replacement surgery.

One of the health care initiative's key techniques is to promote what it calls Real-Time Safety, described this way: When errors are buried, the opportunity to learn from them is lost.

The goal for this area of the initiative is for the staff to alert the system about every medication error and break in practice that might result in an infection. Each deviation from standard practice will be investigated to its root cause within 24 hours, as close as possible to where the work is done. Results of these rapid root-cause analyses will be shared with everyone in the organization, regionally and, ultimately, throughout the nation.

Real-time problem-solving stands in stark contrast with the way error reporting and investigation are usually done in health care. Raising problems as they occur places enormous demands on leaders and forces institutions to become adept at solving problems rapidly.

The real-time system is inspired by the one in use at Alcoa, where the lost workday rate is now 16 times better than the average American hospital.

PRHI personnel can help hospitals put their systems to full use, tracking problems and their root causes. Reporting, learning and improvement occur when employees feel professionally safe, and when top hospital management creates a blame-free, non-punitive environment along with the expectation that every problem will be revealed.

Introducing such a system into a professionally safe environment can rapidly accelerate progress toward zero medication errors and zero infections through rapid, decentralized problem-solving.