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To Err Is Human
Building a Safer Health System

Linda T. Kohn, Janet M. Corrigan, and
Molla S. Donaldson, Editors
Committee on Quality of Health Care in America
INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.

Copyright 2004 © National Academy of Sciences. All rights reserved.
Unless otherwise indicated, all materials in thisPDF File provided by the National Academies Press (www.nap.edu) for research
purposes are copyrighted by the National Academy of Sciences. Distribution, posting, or copying is strictly prohibited without
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NATIONAL ACADEMY PRESS • 2101 Constitution Avenue,N.W. • Washington, DC 20418

NOTICE: The project that is the subject of this report was approved by the Governing
Board of the National Research Council, whose members are drawn from the councils of
the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen
for their special competencesand with regard for appropriate balance.
Support for this project was provided by The National Research Council and The
Commonwealth Fund. The views presented in this report are those of the Institute of
Medicine Committee on the Quality of Health Care in America and are not necessarily
those of the funding agencies.
Library of Congress Cataloging-in-Publication Data
To err is human :building a safer health system / Linda T. Kohn, Janet M. Corrigan, and
Molla S. Donaldson, editors.
p. cm
Includes bibliographical references and index.
ISBN 0-309-06837-1
1. Medical errors—Prevention. I. Kohn, Linda T. II. Corrigan, Janet. III.
Donaldson, Molla S.
R729.8.T6 2000
362.1—dc21
99-088993
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The full text of this report is available on line at www.nap.edu/readingroom.
For more information about the Institute of Medicine, visit the IOM home page at
www.iom.edu.
Copyright 2000 by the NationalAcademy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost
all cultures and religions since the beginning of recorded history. The serpent adopted as
a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held
by the Staatliche Museen in Berlin.

Copyright 2004 ©National Academy of Sciences. All rights reserved.
Unless otherwise indicated, all materials in this PDF File provided by the National Academies Press (www.nap.edu) for research
purposes are copyrighted by the National Academy of Sciences. Distribution, posting, or copying is strictly prohibited without
written permission of the NAP.
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National Academy of Sciences
National Academy of Engineering
Institute of Medicine
National Research Council

The National Academy of Sciences is a private, nonprofit, self-perpetuating society
of distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use forthe general welfare. Upon the
authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters.
Dr. Bruce M. Alberts is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter
of the National Academy of Sciences,...
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