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LETTERS: David I Ben-Tovim Seeing the picture through "lean thinking" BMJ 2007; 334: 169 [Full text]

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Patient Safety, Audit and Proactive Risk Assesment

Allan D spigelman   (29 January 2007)

Patient Safety, Audit and Proactive Risk Assesment 29 January 2007
Allan D spigelman, Professor of Surgery, University of New South Wales St Vincents Clinical School (UNSW), Sydney, NSW, Australia, 2010 Send response to journal: Re: Patient Safety, Audit and Proactive Risk Assesment	In responding to the editorial by Vincent (BMJ 2007; 334: 51) David Ben-Tovim (BMJ 2007;334:169) urges abandonment of "further retrospective error analysis" and of clinical audit and feedback in favour of prospective examination of system processes. As the founding (and former) Director of Autralia's first Clinical Governance Unit, I strongly agree with prospective risk management, having employed it to address system issues in areas such as retrieval of critically ill patients and replacement of ageing equipment. Clinical audit and error reporting, however, must continue. The community requires such data so as to be able to judge performance. Clinical staff should report in the context of a just culture to ensure that the most critical incidents receive timely review and that unrecognised system and personal deficiencies do not remain hidden. Audit, error reporting and prospective risk management are mutually supportive, not exclusive. Competing interests: None declared