Healthcare delivery systems are complex and increasingly dependent on good teamwork, shared values, and accurate information. There is increasing recognition in the United Kingdom and elsewhere that, in addition to the contractual and professional duties of clinicians, the quality of management and the health of organizations have a major bearing on reducing risks to patients and providing a quality service. Although medical negligence cases are increasing in the United Kingdom, there is evidence that openness and early involvement of patients and their relatives, as well as operational staff, in handling untoward incidents is often a good defence against litigation. Similarly, in planning developments and changes in healthcare delivery, early and full involvement of key stakeholders is likely to prevent problems later.

Four of the American cases (chapters 7, 8, 10, and 11) are now reviewed by two experienced, former senior National Health Service (NHS) managers, one now working as an academic and consultant, the other chairing one of the newly created national bodies concerned with quality in the NHS. Lessons have been drawn from the cases from a UK perspective and suggestions provided as to how the cases may have been better handled.

Medical errors: Paradise Hills Medical Center

Radiation overdose is not uncommon, and this case has parallels with similar ones in the United Kingdom – notably one in the Exeter radiotherapy centre in the late 1980s (Thwaites Report 1988).