To the EDITOR: Bates et al. discuss the continued prevalence of adverse events in medical care and highlight important opportunities for improvement, thereby furthering the observation that patient care is “still not safe.”1 However, we are surprised to see only cursory recognition of organizational practices and leadership as targets of improvement, despite substantial evidence linking these factors to patient safety.1-3 Research in the organizational sciences investigates how these types of nonclinical structures, systems, and interpersonal behaviors contribute to adverse performance. Yet this work remains largely absent from discourse on patient safety (and medicine more generally),3 which contributes to an overly narrow, clinical lens for interpreting adverse events.
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