Twenty years ago, few systematic efforts to make health care safer existed. Today, patient safety is a priority for patients, providers, payers, and policy makers. The Institute of Medicine’s 1999 report on medical error prompted a flurry of activity, including widespread adoption of error detection and reporting programs, movement toward systems approaches for addressing error, development of new clinical interventions to reduce error, and efforts to foster stronger safety cultures within healthcare organizations. Although there are some indications that these activities have yielded benefits, it is also evident that much of health care, including cardiovascular medicine, remains too unsafe.

Mirroring the heterogeneity and complexity of errors in health care, the myriad initiatives underway to improve safety are multifaceted and wide ranging, which makes it difficult to overview them. However, many of the initiatives that involve legal and policy-based interventions may be characterized according to their alignment with 1 of the following 4 general approaches: greater transparency; financial incentives; new forms of regulation emanating from both inside and outside the provider community; and reform of the liability system.

As patient safety improvement initiatives grow in scope and impact, understanding their precise role, effects, and limitations will become increasingly important for physicians and hospitals. Cardiologists, cardiac surgeons, and health services and policy researchers working on cardiovascular disease are especially likely to encounter these initiatives. Cardiac conditions are highly visible, frequently associated with substantial morbidity and mortality, and expensive, which helps to explain why cardiovascular care is often targeted for improvement efforts. In this article, we review the leading approaches to patient safety improvement, addressing both their rationale and available evidence of their effectiveness. We conclude with discussion of some implications for clinical practice.