Tell me about the context, and more.

The scholarly publication of patient safety initiatives must contribute more to accelerating reliable, safe patient care. Reports of safety initiatives generally describe specific safety practices and the resulting clinical outcomes. So why is progress so slow to make patients safer? Do the reported safety practices in such reports in fact lack convincing and plausible supporting evidence? Or, do the patient safety practices work, but require more explicit attention to implementation strategies? We suggest “Yes”dto both questions. Moreover, context lies at the heart of the answers to both. The lack of useful focus on context has led to heterogeneity in both evaluation of effective patient safety practices and successful implementation strategies. In this issue of BMJ Quality & Safety, three papers report a project led by researchers from RAND with a national team of US researchers and international group of technical advisors that investigated the role of context in scholarly patient safety reports. Together with an earlier paper from the same group, they found that few reports actually define context in sufficient detail to offer strategies for replication. They report that most publications omit any empirical assessment of the impact of context on implementation of safety practices. They also provide an extensive list of specific contextual elements relevant to patient safety interventions and a typology for organising them. 9