According to Paul M. Schyve, MD, Senior Vice President of the Joint Commission on Accreditation of Healthcare Organizations, the good news is that the science, patient safety tools, and our knowledge of safe practices have advanced rapidly since the 1999 Institute of Medicine report on error in health care. Unfortunately, as difficult as this process of change has been, it is the "easy" phase. According to Schyve, developing and maintaining a safe culture is the "hard" phase — the real, underlying challenge to successfully applying safety science and safe practices throughout health care.

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