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This paper considers some implications of recent developments relating to patient safety for understandings of trust in health care contexts.

Conceptual analysis focusing on patients' trust in health care providers and health care providers' trust in patients.

Growing awareness of the scale of the problem of iatrogenic harm has prompted concerns that patients' trust in health care providers may be threatened and/or become inappropriate or dysfunctional. In principle, however, patients' trust may be both well placed and compatible with current understandings of safety problems and efforts to address these. Contemporary understandings of patient safety suggest that, to be deemed trustworthy, health care providers should make vigorous efforts to improve patient safety, be honest about safety issues, enable patients to contribute effectively to their own safety, and provide appropriate care and support after safety incidents. Patients who trust health care providers need not be ignorant of patient safety problems and may be vigilant in the course of their care. Iatrogenic harms do not necessarily reflect breeches of trust (not all such harms are yet preventable), and patients who are harmed might in some circumstances appropriately forgive and resume trusting. Health care providers may feel vulnerable to patients in several respects. From their perspective, trustworthy patients will act competently to optimise the outcomes of their health care efforts and to preserve health care providers' good reputations where those are justified. Providers' trust in patients may strengthen patients' trust in them and facilitate safety improvement work.

Shows how, in principle, trust can be compatible with current understandings of patient safety issues and may enhance efforts to improve patient safety.

The purpose of this paper is to inform healthcare providers and healthcare facility leadership about the statutory, administrative, criminal, and tort law implications related to preventable harms from unsafe injection practices.

Review of legal theory and precedents.

The law can address disputes over unsafe injection practices in a variety of ways. Administrative agencies may hold a provider or facility responsible for preventable harms according to specific statutory and regulatory provisions governing licensure. State courts can compensate victims of certain actions or inactions based on tort law, where a breach of a legal duty caused damages. Prosecutors and the public can turn to criminal law to punish defendants and deter future actions that result in disability or death.

The state law findings in this review are limited to legal provisions and court cases that are available on searchable databases. Due to the nature of this topic, many cases are settled out of court, and those records are sealed from the public and not available for review.

Preventable harm continues to occur from unsafe injection practices. These practices pose a significant risk of disease or even death for patients and could result in legal repercussions for healthcare providers and facility leadership.

This article reviews emerging law and potential legal implications for health care and public health related to unsafe medical practices related to needle, syringe, and vial use.

The purpose of this paper is to examine the role of prior-CSR reputation in protecting a company’s CSR reputation during product-harm crises and how it influences consumers’ crisis-related behavioral intentions (i.e. supportive communication, resistance to negative information and crisis resiliency). The authors test whether the impact of prior-CSR reputation differs by crisis type as well.

A randomized 2 (CSR reputation: good vs bad) × 2 (product-harm crisis type: tampering vs preventable) full factorial design in two industry settings (food industry and retail industry) with consumer samples was conducted.

The results revealed the determinant role of positive prior-CSR reputation in protecting reputational assets. A company with positive CSR reputation experiences no decrease in its CSR reputation during victim crises and fairly minor decreases during preventable crises. However, a company with a bad prior-CSR reputation experiences a greater decline in its CSR reputation across both crises; the level of decline during victim crises was as substantial as the decline experienced during a preventable crisis. The prior-CSR reputation directly affects consumers’ crisis-related intentions, and indirectly does so through post-CSR reputation. As post-CSR reputation becomes more positive, consumers display greater resistance to negative information, supportive communication intent and crisis resiliency.

This study advances the understanding of the role of corporate reputation during crises and provides additional empirical evidence of how the buffering effect of CSR can extend beyond product-related intentions among consumers. The findings can induce companies to adopt CSR programs more systematically and proactively under a long-term strategic plan.

The purpose of this paper is to provide a practical framework that health care organizations could use to decrease preventable healthcare-acquired harms.

An existing theory of how hospitals succeeded in reducing rates of central line-associated bloodstream infections was refined, drawing from the literature and experiences in facilitating improvement efforts in thousands of hospitals in and outside the USA.

The following common interventions were implemented by hospitals able to reduce and sustain low infection rates. Hospital and intensive care unit (ICU) leaders demonstrated and vocalized their commitment to the goal of zero preventable harm. Also, leaders created an enabling infrastructure in the way of a coordinating team to support the improvement work to prevent infections. The team of hospital quality improvement and infection prevention staff provided project management, analytics, improvement science support, and expertise on evidence-based infection prevention practices. A third intervention assembled Comprehensive Unit-based Safety Program teams in ICUs to foster local ownership of the improvement work. The coordinating team also linked unit-based safety teams in and across hospital organizations to form clinical communities to share information and disseminate effective solutions.

This framework is a feasible approach to drive local efforts to reduce bloodstream infections and other preventable healthcare-acquired harms.

Implementing this framework could decrease the significant morbidity, mortality, and costs associated with preventable harms.

The purpose of this paper is to examine the preventable harm created by the adoption of austerity measures in 2010, added to the welfare reforms introduced in 2008 which, collectively, have negative implications for population mental health in the UK.

A critical reflection of published research papers and key policy documents in this area.

Negative mental health consequences of the combined impact of welfare reforms and austerity measures in the UK since 2010 are identified when relating to disability benefit assessments, and to the increased punitive conditionality applied to disability benefit claimants, as those in greatest need now live in fear of making a claim for financial support from the state or of losing benefits to which they are entitled.

This paper identifies the creation of preventable harm by social policy reforms, commonly known as “welfare reforms”. The implications for social scientists are the disregard of academic peer-reviewed social policy research by policymakers, and the adoption of critically challenged policy-based research as used to justify political objectives.

The negative mental health impact of UK government social policy reforms has been identified and highlights the human consequences of the adoption of the biopsychosocial model of assessment.

Reducing the numbers of sick and disabled people claiming long-term disability benefit has increased the numbers claiming unemployment benefit, with no notable increase in the numbers of disabled people in paid employment and with many service users in greatest need living in fear of the next enforced disability assessment.

This paper demonstrates the preventable harm created by the use of a flawed disability assessment model, together with the adoption of punitive conditionality and the increased suicides linked to UK welfare reforms which are influenced by American social policies.

Much of the discussion surrounding the antivaccine movement focuses on the decision of parents to not vaccinate their children and the resulting danger posed to others. However, the primary risk is borne by the child left unvaccinated. Although living in a developed country with high vaccination rates provides a certain amount of protection through population immunity, the unvaccinated child is still exposed to a considerably greater risk of preventable diseases than one who is vaccinated. I explore the tension between parental choice and the child’s right to be free of preventable diseases. The chapter’s goal is twofold: to advocate for moving from a dyadic framework – considering the interests of the parents against those of the state – to a triadic one, in which the interests of the child are given as much weight as those of the parent and the state; and to discuss which protections are available, and how they can be improved. Specific legal tools available to protect that child are examined, including tort liability of the parents to the child, whether and to what degree criminal law has a role, under what circumstances parental choice should be overridden, and the role of school immunization requirements in protecting the individual child.

No civilian has any comprehension of life in British military forces, or the impact of the removal of that life when unexpectedly returned to “Civvy Street” following the onset of a permanent illness or profound disability, with the gradual realisation that support in the civilian world means that a disabled veteran is just one of a crowd. The paper aims to discuss this issue.

Participant observation.

Welfare reforms together with austerity measures introduced by the British government are causing preventable harm to the most vulnerable in society.

This paper was written by invitation and is limited by word length.

Older working-age disabled veterans are being abandoned by the state and suffer due to a change in government social policy.

Disregarding the suffering and preventable harm created in society by the ongoing welfare reforms will have consequences that will need to be addressed as a matter of urgency, as the often tragic consequences are eventually alerted to the public.

A demonstration that the older working-age disabled veterans are being harmed by welfare reforms and the armed forces covenant has been breached.

Early writings about teamwork in healthcare emphasized that healthcare providers needed to evolve from a team of experts into an expert team. This is no longer enough. As patients, accreditation bodies, and regulators increasingly demand that care is coordinated, safe, of high quality, and efficient, it is clear that healthcare organizations increasingly must function and learn not only as expert teams but also as expert multiteam systems (MTSs).

In this chapter, we offer a portrait of the robust, and albeit complex, multiteam structures that many healthcare systems are developing in order to adapt to rapid changes in regulatory and financial pressures while simultaneously improving patient safety, quality, and performance.

The notion of continuous improvement rooted in continuous learning has been embraced as a battle cry from the boardroom to the bedside, and the MTS concept offers a meaningful lens through which we can begin to understand, study, and improve these complex organizational systems dedicated to tackling some of the most important goals of our time.

Workplaces vary enormously in the amount of harmful stress they produce, even within specific economic sectors. Stress of certain kinds and at certain levels tend to produce health harms and costs that are borne not only by individual employees and employers but also by families and society at large. Variations in stress levels within economic sectors can be traced to variations in management practices that govern key conditions of work involving demand, effort, control and reward. The costs of stress‐related disorders produced by adverse governance practices are transferred outside the workplace in varying degrees. The actual extent of this cost transfer depends on policies and programs within the workplace. We can characterize workplaces according to a typology in which the key dimensions are commitment to abate harm through participatory management practices and the effectiveness and efficiency of harm containment through programs such as employee assistance and health promotion. The most health‐promoting and cost‐avoiding workplaces foster high control, high reward conditions and support employees with employee assistance and health promotion programs. The policy implications of this observation are drawn out.

Healthcare governance places medical ethics at the forefront of defining and maintaining the quality of care. Examples of serious ethical issues include sexual abuse of patients (Dubois, Walsh, Chibnall et al., 2017), criminal prescription of opioids (Johnson, 2019) and unnecessary surgical procedures (Tayade and Dalvi, 2016) or shortages in service delivery because of little knowledge or experience especially during pandemic outbreaks (Hay-David et al., 2020). In many cases involving medical ethics, patients are identified as the first victims; however, this study aimed to consider clinicians and other healthcare practitioners as other probable victims (Ozeke et al., 2019).

The World Health Organization (WHO) estimates that tens of millions of patients worldwide suffer disabling injuries or death every year due to unsafe medical practices and services. Nearly, one in ten patients is harmed due to preventable causes while receiving health care in well-funded and technologically advanced hospital settings (WHO, 2016). Much less is known about the burden of unsafe care in non-hospital settings, where most healthcare services are delivered (Jha et al., 2013). Furthermore, there is little evidence concerning the burden of unsafe care in developing countries, where the risk of harm to patients is likely to be greater, due to limitations in infrastructure, technologies and human resources (Elmontsri et al., 2018).

While these problems are endemic in health care, they are exacerbated in times of health and social crises such as the coronavirus disease of 2019 (COVID-19) pandemic. This pandemic has few precedents, being most closely paralleled with the global influenza pandemic of 1918 (Terry, 2020). Initially compared to the severe acute respiratory syndrome (SARS) outbreak of 2002–2003 (Parrym, 2003), COVID-19 is already proving much more deadly. The WHO’s estimates of the number of SARS cases from the start of the outbreak in 2002, until it was brought under control in July 2003, was 8,437 cumulative cases, with 813 deaths (WHO, 2003). The European Center for disease prevention and Control estimated that as of May 15, 2020, that 4,405,680 cases of COVID-19 have been reported with 302,115 deaths (ECDC, 2020)

The outbreak of COVID-19 was declared in February 2020 in the Islamic Republic of Iran, and up to March 2020, the cases of morbidity reached 12,729, with 611 deaths (Bedasht, 2020). The current figure at the time of editing (May 16, 2020) is 118,392 cases, with 6,937 deaths (Worldometer, 2020). Acting in cognizance of its ethical responsibility to the citizens of Iran, the Iranian government has taken the following action to attempt to mitigate the deleterious effects of the virus: in each province, one or more hospitals have been evacuated and allocated to patients with pulmonary problems with suspected to COVID-19. Access to intensive care units and specialist equipment is a primary ethical issue that concerns the Iranian healthcare system. The issue is exacerbated by the knowledge that these facilities are not distributed equitably in the country. Therefore, equity is the first ethical concern in this situation.

All nurses, clinicians, practitioners and specialists have been asked to volunteer their services in hospitals in the most infected areas. This raises ethical concerns about access to personal protective equipment (PPE) such as appropriate masks, gowns, gloves and other equipment to protect healthcare workers from infection. Access to PPE was restricted because of government failure to stockpile the necessary amount of disposable medical equipment. This was related to lack of domestic capacity to produce the equipment and problems accessing it internationally due to political-economic sanctions that were imposed on Iran by the USA and some European countries. Such shortages can quickly lead to a catastrophic situation; current evidence demonstrates that about 40% of healthcare workers are vulnerable to the COVID-19 infection (Behdasht, 2020). However, it should be noted that this is not a problem limited to Iran. As of March 2020, the WHO was already warning about PPE shortages and the dangers this posed for healthcare workers around the world (WHO, 2020).

A Disaster Committee was created by the Iranian Ministry of Health to take responsibility for decision-making and daily information sharing to the community. The ethical dilemma that arises in terms of reporting the situation is the conflict between transparently presenting accurate and timely information and the creation of public panic and fear that this may cause in the community.

As a steward for public health, the Ministry of Health was afforded direct responsibility to maintain intra-sector relationships and leadership with other organizations such as political executive organizations, municipalities, military agencies, schools, universities and other public organizations to reach consensus on the best methods of controlling the COVID-19 outbreak. An important ethical issue is found in potential areas of conflict between the therapeutic and preventive roles of the Ministry of Health and those related to public health and the civil administrations.