Despite years of efforts to fix the nation's error-ridden health-care system, leading safety experts say Americans aren't much safer than they were five years ago -- and too many conflicting safety programs may be part of the problem.

Now, a coalition of health-care purchasers, quality groups and government agencies working with the National Quality Forum, the leading government advisory body on health-care quality measurement and standards, have agreed for the first time to endorse a single set of 30 "safe practices" that all hospitals should use to prevent death and injury to patients. The agreement comes after a two-year effort to harmonize the dizzying and often conflicting array of safety guidelines that have sprung up since 2000 in response to the landmark Institute of Medicine report, "To Err Is Human," which found that as many as 100,000 patients die each year from medical mistakes.

The NQF, which includes groups representing consumers, employers, health-care professionals, health plans and labor unions, will formally issue the new safety practices after a comment period that ends Nov. 14. The new practices will replace an outdated set first issued in 2003. They will add several important new protections for patients such as requirements that hospitals disclose medical errors promptly to patients and families who are affected, adopt evidence-based programs to prevent medical errors during hand-offs of patients between nursing shifts, and evaluate non-nursing staff who care for patients to ensure they are competent to provide safe care.

Some of the practices seem vague and general, such as creating a "culture of patient safety." Others are already widely accepted standards of care, but simply aren't being followed, such as protocols for preventing wrong-site surgery by marking patients' limbs "NOT THIS ONE" and preventing pneumonia in patients on ventilators with a simple set of care measures such as elevating the head of the bed.

When the NQF issues the safe practices guidelines, it will include detailed guidance on how to implement them, including examples of programs hospitals can use to train staff to convey difficult information to patients, discuss end-of-life care, and disclose bad outcomes. Mr. Denham's group is hosting free workshops around the country to help hospitals train staffers to adopt the new safety procedures, which will be open to consumers. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality, is also unveiling some new tools and training programs for hospitals, including incentives to adopt information technology that can intercept medication errors.

Among the groups that advised the committee to create the new measures are the Leapfrog Group, a coalition of large employers that surveys hospitals on safety and quality measures; the federal Centers for Medicare and Medicaid Services; the Joint Commission on Accreditation of Health Care Organizations, the leading hospital accrediting body, and the Institute for Healthcare Improvement, a nonprofit group which leads hospitals in safety collaborative programs. Providers such as managed-care giant Kaiser Permanente also participated in the effort.

By creating a single roadmap for hospitals to improve safety, "we've taken a major stumbling block away, so there are no excuses anymore," says Charles Denham, who co-chaired the committee that developed the new safe practices and runs the non-profit Texas Medical Institute of Technology, which designs surveys for Leapfrog and works with hospitals to test safety measures. For consumers, the practices provide a "litmus test to know whether their hospital is serious about quality," Dr. Denham says. Consumers will be able to view the measures on the NQF Web site at qualityforum.org.

Though voluntary, the NQF practices will likely be incorporated into the growing number of programs that reward those who take steps to improve safety and penalize those who don't. Members of The Leapfrog Group, for example, use hospital-safety surveys to create public report cards and negotiate contracts with hospitals and health care providers, referring employees to high-scoring respondents, and steering them away from those that don't measure up. Medicare and private insurers are expected to use the safety practices in "pay-for-performance" programs that provide incentives for compliance. And by failing to comply with safety practices, hospitals risk losing credentials they need from the Joint Commission to be reimbursed by Medicare and private insurers.

According to the NQF, adverse health-care events continue as a leading cause of injury and death even though well-documented methods are available that could prevent them, and health care as an industry has been slow to fix badly flawed processes that lead to adverse events like medication errors, wrong-site surgeries, and hospital infections. Part of the problem, experts say, is that hospitals are paid no matter what the outcome of their services.

But a lack of coordination among safety and quality programs hasn't helped either. Mounting demand for safety data and quality reports from employers, insurers, and government agencies has led to confusion and resistance from hospitals, who say they've been swamped by differing standards and guidelines and are wasting time and money trying to collect and analyze data.

Dennis O'Leary, a physician who is president of the Joint Commission, warns that hospitals may not be able to meet all 30 of the new practices at one time, either. Some pioneering hospitals have adopted methods to prevent errors and improve safety from process redesign strategies used in industries like airlines and manufacturing. For example, many are adopting the Six Sigma program for reducing manufacturing defects, using workflow charts and audits to see where mistakes, errors, and delays happen, or to speed up slow moving processes such as the delivery of critical test results. During shift changes, when the majority of errors occur, nurses are using communications models adapted from a program to quickly brief submariners during a change in command. But as few as 10 percent of hospitals his group accredits have comprehensive safety programs that use such formal methods, and 15 percent to 30 percent of them aren't compliant with standards such as making sure patient errors aren't made in hand-offs between shifts, reporting critical test errors in a timely manner, reading back verbal orders to ensure accuracy, and making sure staffers wash their hands. "We want these changes to happen but our concern is that if you ask hospitals to do too much at once, the risk is they won't do anything well," Dr. O'Leary says.

Janet Corrigan, president of the National Quality Forum says that by aligning efforts around a single set of standards, "we have a much better chance of being able to focus limited resources on those areas that evidence shows will achieve the greatest gains and lead to better safety for patients."