George Washington University Hospital, for example, has initiated a root-cause analysis that inspects the activities leading up to a serious safety breach and devises steps to prevent a recurrence.

Hospitals have incident-reporting systems to keep track of mistakes and lapses, patient-safety officers, patient-outcome reviews, quality-control personnel, and quality committees. New medication-administration methods and other information technologies designed to reduce errors are becoming a routine part of running a hospital. As one local hospital administrator says, "Whether we're forced to or not, we have to look at our performance or we're in real trouble."

One way hospitals measure performance is by comparing themselves to others of similar size. All the hospitals in the Inova system compare data internally, and Inova Fairfax is one of more than 190 hospitals across the country that are part of a nonprofit organization called the Institute for Healthcare Improvement, which shares and compares clinical data. Georgetown University Hospital is a member of the University HealthSystem Consortium, 90 similar-size hospitals that compare data quarterly to see how each is doing. "It forces you to look hard at how you are doing clinically," says hospital president Dr. Joy Drass.

But little of this information ever gets to the public. "The publicly available data is incomplete," says Carolyn Simonsen, head of quality and care management at Holy Cross Hospital. There is lots of information, such as infection rates, that hospitals use to compare themselves with other hospitals, "but it's not available to the public."