Newborn screening: A complex system that requires a culture of safety.

As health care providers and organizations, we have a responsibility to examine our practices and systems for opportunities to improve quality and health outcomes. Today a critical opportunity exists in the newborn screening (NBS) system, which touches every one of the approximately 4 million babies born annually in the United States. This opportunity involves improving the quality of NBS by developing a culture of safety to prevent errors that in NBS represent missed babies and preventable morbidity and mortality. This commentary will explore the "culture of safety" for NBS, including the high reliability organization (HRO) paradigm and normal accident theory (NAT), which have been effective in reducing systems failures in other complex environments.