This AHRQ–funded study directly observed residents and attendings in the medical intensive care unit and trauma surgery services at an academic medical center with the goal of examining responses to errors and near misses. The authors analyzed the positive and negative aspects of specific features of the physician work culture, including the "aloofness" of attending physicians, the emphasis on avoiding "surprises" in discussing clinical information, and "pimping" of residents by attendings. Although multiple errors and near misses were observed, these were generally not used as learning opportunities, as has been found in prior research. Specific techniques that encourage a learning culture, such as providing feedback and encouraging inquiry, were rarely used in response to errors.

An exploration of the role that organizational factors play in achieving patient safety improvement. The authors conclude that little evidence exists to support the impact an individual or organizational component has on minimizing error. Improvements needed to increase the effectiveness of future research are reviewed.