Learning from error
‘Learning from error, rather than seeking someone to blame, must be the priority in order to improve safety and quality.’
The Report of the Public Inquiry into children's heart surgery at the Bristol Royal Infirmary 1984-1995: Learning from Bristol, July 2001
From its inception as a concept, clinical governance has learned from failures. A landmark inquiry into the deaths of over 30 children at the Bristol Royal Infirmary between 1991 and 1995 (Bristol Inquiry) was an early exemplar of how learning from errors can inform improvements to safety and quality, and hence clinical governance.
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