Partial truths in the pursuit of patient safety

The paper explores several issues in the form of partial truths that dominate current thinking as investigators continue their pursuit of patient safety. Among the partial truths examined−cast as bipolar orientations−are evidence-based medicine versus quality improvement, 'knowledge in the head' versus 'knowledge in the world', sharp end versus blunt end, reporting systems versus local knowledge, changing beliefs versus changing behaviour and system components versus system interdependencies. The paper provides a cautionary note regarding the downside of creating dichotomies that tend to assert too much. An enhanced understanding of patient safety will likely result from rising above bipolar orientations and valuing them as partial approaches to a complex and dynamic problem space.