Whatever paradigm is used, there are important distinctions to clarify, especially when quality is assessed in case reviews and judgments made about causality and preventability. Because language can be slippery when applied to real life situations, it is worth asking users to explicitly state exactly what they mean:
- Were the standards used to assess care established a priori, before an event, or was something declared to be “an error” or “substandard” only after an event in which a patient was harmed?
- How were judgments of “error” and preventability determined? If an established standard of care was violated, did contextual circumstances make the actions or decisions taken (or not taken) the best options in the moment?
- Was a judgment about the adequacy of care based on an established standard of care, expert consensus, or other criteria?
While precise language can help guide assessments, it does not always remove ambiguity in assessments since post hoc certainty may appear to be objective but may rest on layers of subjective determinations.
