Challenges in delivering safe patient care: a commentary on a quality improvement initiative

The specific aim of this commentary is to identify the challenges identified by nurses in the delivery of safe patient care. In reporting, some of the messages emanating from the research and policy literature, the paper highlights the importance of taking a system approach to the investigation of patient safety failures, the conflicting evidence relating to patient deaths as a result of failures in safety, and the underlying importance of culture. The paper outlines the reasons why patient safety has become so prominent, and provides a brief description of some of the definitions and terminology in current use. The commentary articulates a number of challenges in the delivery of safe care as identified by nurses during a recent quality improvement initiative, and these are organized under the themes of organizational context, working environment, and the organization and management of care. In conclusion, the paper describes the implications arising from the quality improvement initiative and the need for further research exploring the nature of safety culture in health-care organizations.