This long list of potential approaches to improving safety (each of which will be discussed in greater detail later) highlights one of the great challenges in the field: in the absence of comparative evidence, and in light of the high cost of some of the interventions (e.g., improved staffing, computerized order entry, simulation, teamwork training), even organizations committed to safety can become bewildered as they consider which approach to emphasize.21 Institutions quite naturally focus on the practices that are measured, publicly reported, and compensated. As the next chapter will show, such a prioritization scheme will tend to elevate quality improvement strategies over those focused on patient safety because the results of the former are easier to measure. Thankfully, many of the approaches to improving quality, such as computerization and standardization, will also yield safety benefits. On the other hand, because improving culture is both difficult and hard to measure, it risks being shuffled to the bottom of the deck, notwithstanding its importance to patient safety. Pronovost, Miller, and I have suggested a measurement scheme for patient safety that takes these considerations into account (Table 2-3).22