The purpose of patient safety work is to reduce avoidable patient harm. This requires us to slay dragons—to eliminate or at least mitigate risks to patients. Instead, current practice focuses almost exclusively on investigating dragons—tracking reports on the number and type of dragons that appear, how many villagers they eat and where, whether they live in caves or forests, and so on. Information about risks is useful to the extent that it informs effective action––but only to that extent. By itself, it does nothing to make patients safer. We cannot investigate a dragon to death. No more can we risk assess our way to safer care.

Recent research by Bates et al¹ adds new evidence to a long-simmering realization: the patient safety movement has stagnated. After a brief convulsion of innovation, the practice of patient safety has settled into a long period of bureaucratization,² bolstered by confidence in its (very real) good intentions and constrained by a hastily developed standard of practice that has not kept pace with advances in safety science.^3–6

This stagnation has stymied safety improvement in a number of ways, but the field’s continuing failure to focus on solutions all but guarantees that patient harm will continue unabated.