No abstract

The Australian Patient Safety Foundation was formed in 1987; it was decided to set up and coordinate the Australian Incident Monitoring Study as a function of this Foundation; 90 hospitals and practices joined the study. Participating anaesthetists were invited to report, on an anonymous and voluntary basis, any unintended incident which reduced, or could have reduced, the safety margin for a patient. Any incident could be reported, not only those which were deemed "preventable" or were thought to involve human error. The Mark 1 AIMS form was developed which incorporated features and concepts from several other studies. All the incidents in this symposium were reported using this form, which contains general instructions to the reporter, key words and space for a narrative of the incident, structured sections for what happened (with subsections for circuitry incidents, circuitry involved, equipment involved, pharmacological incidents and airway incidents), why it happened (with subsections for factors contributing to the incident, factors minimising the incident and suggested corrective strategies), the type of anaesthesia and procedure, monitors in use, when and where the incident happened, the experience of the personnel involved, patient age and a classification of patient outcome. Enrolment, reporting and data-handling procedures are described. Data on patient outcome are presented; this is correlated with the stages at which the incident occurred and with the ASA status of the patients. The locations at which the incidents occurred and the types of procedures, the sets of incidents analysed in detail and a breakdown of the incidents due to drugs are also presented. The pattern and relative frequencies of the various categories of incidents are similar to those in "closed-claims" studies, suggesting that AIMS should provide information of relevance to those wishing to develop strategies to reduce the incidence and/or impact of incidents and accidents.

No abstract

The phrase "Washington Consensus" has become a familiar term in development policy circles in recent years, but it is now used in several different senses, causing a great deal of confusion. In this article the author distinguishes between his original meaning as a summary of the lowest common denominator of policy advice addressed by the Washingtonbased institutions (including the World Bank) and subsequent use of the term to signify neoliberal or market-fundamentalist policies. He argues that the latter policies could not be expected to provide an effective framework for combating poverty but that the original advice is still broadly valid The article discusses alternative ways of addressing the confusion. It argues that any policy manifesto designed to eliminate poverty needs to go beyond the original version but concludes by cautioning that no consensus on a wider agenda currently exists. Ten years ago I invented the term "Washington Consensus" to refer to the lowest common denominator of policy advice being addressed by the Washington-based institutions to Latin American countries as of 1989 (Williamson 1990). While it is jolly to become famous for coining a term that reverberates around the world, I have long been doubtful about whether my phrase served to advance the cause of rational economic policymaking. My initial concern was that the phrase invited the interpretation that the liberalizing economic reforms of the past two decades were imposed by Washington-based institutions (for example, see Stewart 1997) rather than having resulted from the process of intellectual convergence that I believe underlies the reforms. 1 Richard Feinberg's "universal convergence" (in Williamson 1990) or Jean Waelbroeck's "one-world consensus" (Waelbroeck 1998) would have been a much better term for the intellectual convergence that I had in mind. I have gradually developed a second and more significant concern, however. I find that the term has been invested with a meaning that is significantly different from that which I had intended and is now used as a synonym for what is often called