Patient/clinician relationships supported by organizational culture and individual wellness efforts are core to the provision of high-quality care and process improvement engagement. This article collection highlights trainee attitudes about patient safety and how respect and support for enhancing the care experience of both patients and those who care for them are foundational to safe, effective care.

The Eisenberg Award honors individuals and organizations who have made significant advancements in the pursuit of safe, high-quality health care. The 2020 honorees are Dr. David Gaba; Veterans Health Administration Rapid Naloxone Initiative, Washington, DC, and Northwestern Medicine Academy for Quality and Safety Improvement, Chicago IL.

Incomplete nursing care is known to affect care quality and safety. This special issue documents the global problem of missed or rationed nursing care in a variety of settings and countries. Articles featured in this special issue examine systemic issues, explore interventions, and evaluate measurement tools.

COVID-19 is a novel coronavirus that harbors a variety of diagnostic, treatment, and management hurdles. This special issue covers a variety of clinical topics including optimal diagnostic methods, near misses, and diagnostic accuracy.   

In this continuing series, high-performance work practices are explored and defined through literature review, case analysis, and research. The authors summarize findings and discuss how best practices can influence quality, safety, and efficiency outcomes. Topics covered include speaking up, central line infection prevention, and business case development.

High reliability attainment is a stated goal for health care organizations. This special issue covers established initiatives at the United States Veterans Health Administration that draw from high reliability principles to improve care. Topics covered include evaluation priorities, safe patient handling and diagnostic safety.

The Eisenberg Awards honor individuals and organizations who have had noteworthy impacts on patient safety and quality improvement. This article collection highlights the work of the 2019 honorees: Gordon D. Schiff, MD; WellSpan Health, York, Pennsylvania; and HCA Healthcare, Nashville, Tennessee.

Research and error reporting are important strategies to uncover problems in health system performance. This special issue highlights vendor transparency and context as important areas of focus to ensure electronic health records (EHR) research and reporting help improve system reliability. The articles cover topics such as a framework for research reporting, design of randomized controlled trials for technology studies, and designing research on patient portal enhancement.

Articles in this special issue report on initiatives undertaken by the Canadian National Patient Safety Consortium with a focus on the effect patient partnerships on initiative priority areas including never events, safety culture and homecare safety improvements.

This special segment shares commentaries and online content that summarize growth and lack of progress in various areas of patient safety since To Err is Human was published. Topics covered include the ineffectiveness of current measures and lack of leadership commitment to the issue. Patient stories and organizational efforts to improve safety are covered in the online segments.

The States Targeting Reduction in Infections via Engagement (STRIVE) initiative was 3-year hospital-based program using a multimodal, evidence-based intervention targeted at reducing healthcare-associated infections (HAI) and strengthening state-hospital relationships to improve infection control efforts. The intervention recruited hospitals with a high burden of HAI; a total of 337 hospitals across 23 states and the District of Columbia participated in the program. The STRIVE intervention consistent of four components: (1) baseline assessment of each participating hospital conducted by a state partner, (2) tiered approach to HAI prevention, (3) educational content, and (4) on-site technical assistance. PubMed citations Central-line Associated Blood Stream Infection (CLABSI) Over the three-year study period, no substantial reduction in CLABSI rates were observed; unadjusted rates decreased from 0.88 to 0.80 infections per 1,000 catheter-days. The authors did observe reductions in central-line catheter use during the study period (24.05 to 22.07 central line-days per 100 patient-days); however, this trend was also documented in the pre-intervention period. Catheter-Associated Urinary Tract Infection (CAUTI) Baseline CAUTI rates at participating hospitals were low. Over the three-year study period, the unadjusted CAUTI rate decreased slightly; unadjusted rates decreased from 1.12 to 1.04 infections per 1,000 catheter-days. Unadjusted urinary catheter use decreased from 21.46 to 19.83 catheter-days per 100 patient-days. Clostridioides Difficile Infection (CDI) The authors observed a statistically significant reduction in Clostridioides difficile infection (CDI) over the three-year period, from 7.0 cases days to 5.7 cases per 10,000 patient-days. However, these decreases mirrored national trends in CDI reduction and are likely attributed to recent emphasis on CDI clinical guidelines, mandated CDI reporting, and the inclusion in value-based purchasing, rather than the STRIVE intervention. Methicillin-Resistant Staphylococcus Aureus (MRSA) Infection. Baseline MRSA rates at participating hospitals were low. Over the three-year period, the unadjusted MRSA rate decreased slightly from 0.075 to 0.071 cases per 1,000 patient-days. State Partner Relationships and HAI Prevention Efforts While STRIVE did not result in quantitative improvements in CAUDI, CLABSI, CDI or MRSA rates, the initiative did strengthen relationships between hospitals and state health departments. Through the baseline assessment, state partners were able to identify gaps in HAI prevention efforts and opportunities to improve partner-hospital relationships. State partners also reported improvements in hospital-level prevention activities over the three-year period, as well as improvements to state partner-hospital relationships.

Obstetrics is a high-risk practice that concurrently manages the safety of mothers and newborns. Articles in this special issue discuss how to address burnout and support resilience in obstetrics and gynecology care. Tactics covered include bundles, checklists, and collaboratives.

Resilience is an organizational characteristic that enables individuals and teams to adapt to chaotic conditions and reduce the potential for failure. This special issue explores the intersection between resilience and high reliability in a variety of theoretical and situational contexts such as in maternity care.

The Eisenberg Award honors individuals and organizations who have made important contributions to patient safety and quality improvement. Spotlighting the accomplishments of the 2018 recipients, this special issue includes an interview with Dr. Brent C. James, as well as articles on programs at The Society of Thoracic Surgeons and BJC HealthCare.

Appropriate deprescribing can reduce the risks associated with polypharmacy, overuse, and accidental overdose. Articles in this special section cover findings from a symposium discussing guidelines for safe discontinuation of medications and research needed to support further understanding of deprescribing practices.

Surgery requires specialized approaches to understand and prevent failure. This special issue features the work of multidisciplinary research teams that explored human factors and ergonomic concerns in the operating room that affect communication between robotic-assisted surgery teams, physical resilience of teams, instrument design and use, and poor implementation of briefings as improvement opportunities.

Obstetrics is a high-risk practice that concurrently manages the safety of mothers and newborns. Articles in this special issue explore various facets of health care quality and safety improvement in the care of women and expectant mothers. Topics covered include the patient experience, safety culture, disparities, program implementation, and clinical trends.

Information technology is prevalent in health care and is associated with both optimized processes and unintended consequences. This publication is a compilation of papers from an international conference that explored the potential of health information technology and the research needed to achieve success. Topics covered include usability, implementation, interoperability, and policy.