Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine

The economic boom of the 1990s veiled a grim reality: in addition to the growing gap between rich and poor, the gap between good and bad quality jobs was also expanding. The postwar prosperity of the mid-twentieth century had enabled millions of American workers to join the middle class, but as author Arne L. Kalleberg shows, by the 1970s this upward movement had slowed, in part due to the steady disappearance of secure, well-paying industrial jobs. Ever since, precarious employment has been on the rise—paying low wages, offering few benefits, and with virtually no long-term security. Today, the polarization between workers with higher skill levels and those with low skills and low wages is more entrenched than ever. Good Jobs, Bad Jobs traces this trend to large-scale transformations in the American labor market and the changing demographics of low-wage workers. Kalleberg draws on nearly four decades of survey data, as well as his own research, to evaluate trends in U.S. job quality and suggest ways to improve American labor market practices and social policies. Good Jobs, Bad Jobs provides an insightful analysis of how and why precarious employment is gaining ground in the labor market and the role these developments have played in the decline of the middle class. Kalleberg shows that by the 1970s, government deregulation, global competition, and the rise of the service sector gained traction, while institutional protections for workers—such as unions and minimum-wage legislation—weakened. Together, these forces marked the end of postwar security for American workers. The composition of the labor force also changed significantly; the number of dual-earner families increased, as did the share of the workforce comprised of women, non-white, and immigrant workers. Of these groups, blacks, Latinos, and immigrants remain concentrated in the most precarious and low-quality jobs, with educational attainment being the leading indicator of who will earn the highest wages and experience the most job security and highest levels of autonomy and control over their jobs and schedules. Kalleberg demonstrates, however, that building a better safety net—increasing government responsibility for worker health care and retirement, as well as strengthening unions—can go a long way toward redressing the effects of today’s volatile labor market. There is every reason to expect that the growth of precarious jobs—which already make up a significant share of the American job market—will continue. Good Jobs, Bad Jobs deftly shows that the decline in U.S. job quality is not the result of fluctuations in the business cycle, but rather the result of economic restructuring and the disappearance of institutional protections for workers. Only government, employers and labor working together on long-term strategies—including an expanded safety net, strengthened legal protections, and better training opportunities—can help reverse this trend. A Volume in the American Sociological Association’s Rose Series in Sociology.

Updated to include a new chapter about the influence of social media and the Internet—the 20th anniversary edition of Bowling Alone remains a seminal work of social analysis, and its examination of what happened to our sense of community remains more relevant than ever in today’s fractured America. Twenty years, ago, Robert D. Putnam made a seemingly simple observation: once we bowled in leagues, usually after work; but no longer. This seemingly small phenomenon symbolized a significant social change that became the basis of the acclaimed bestseller, Bowling Alone, which The Washington Post called “a very important book” and Putnam, “the de Tocqueville of our generation.” Bowling Alone surveyed in detail Americans’ changing behavior over the decades, showing how we had become increasingly disconnected from family, friends, neighbors, and social structures, whether it’s with the PTA, church, clubs, political parties, or bowling leagues. In the revised edition of his classic work, Putnam shows how our shrinking access to the “social capital” that is the reward of communal activity and community sharing still poses a serious threat to our civic and personal health, and how these consequences have a new resonance for our divided country today. He includes critical new material on the pervasive influence of social media and the internet, which has introduced previously unthinkable opportunities for social connection—as well as unprecedented levels of alienation and isolation. At the time of its publication, Putnam’s then-groundbreaking work showed how social bonds are the most powerful predictor of life satisfaction, and how the loss of social capital is felt in critical ways, acting as a strong predictor of crime rates and other measures of neighborhood quality of life, and affecting our health in other ways. While the ways in which we connect, or become disconnected, have changed over the decades, his central argument remains as powerful and urgent as ever: mending our frayed social capital is key to preserving the very fabric of our society.