The problem of engaging hospital doctors in promoting safety and quality in clinical care.

There is widespread agreement that the medical profession has much to learn about addressing adverse events in clinical practice and participating in clinical governance. In England and Wales centrally driven initiatives such as medical audit, clinical governance and the National Reporting and Learning System have failed to transform the management of iatrogenic adverse events. In this article we explore the historical and cultural background of these issues with respect to hospital medicine and suggest means of tackling the challenges ahead.