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After years of "the culture of silence," medical error and patient safety have become topics for open discussion. Public expectations of greater transparency have combined with a widening focus on systemic contributions to error. For example, the Canadian Institutes of Health Research and the Canadian Institute for Health Information have issued a call for proposals to study health-system error in Canada. At Health Canada, the Therapeutic Products Directorate now collects data on medication error as part of its monitoring of adverse drug events. Other Canadian institutions with an interest in system improvement and patient safety include the CQI Network, which offers workshops on planning and implementing quality improvement, the National Association of Pharmacy Regulatory Authorities, the Canadian Society of Hospital Pharmacists and the Canadian Nurses Association. Halifax bioethicist Chris MacDonald has collected links to organizations, institutes, publications and reports under the title Ethical Aspects of Clinical Error and Patient Safety. In the US, the Institute of Medicine's Quality of Health Care in America Project has produced an influential report on the scale and causes of and solutions for medical error, Crossing the Quality Chasm: A New Health System for the 21st Century. The US Agency for Healthcare Research and Quality has information on error occurrence and preventive measures. The Institute for Safe Medication Practices in the US has been collecting data and issuing warnings and recommendations on medication error for more than 25 years. ISMP Canada, an independent nonprofit agency with close ties to its American counterpart, was created in 1999. Its Web site offers an anonymous reporting system for medication errors, as well as newsletters and a list of links to collaborating organizations. — Alison Sinclair, CMAJ
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