Nebeker's definition of "harm" is now accepted nationally and includes any care-delivery action that creates long-term impairment or death, that raises the cost of care by requiring additional monitoring or intervention or that creates significant patient symptoms. The definition is deliberately broad.

"When you are trying to find opportunities to improve, you turn over every rock," James says. "The only reason to define events narrowly is if they are directly associated with blame. In this sense, systems that try to identify failure in order to fix blame work directly against well-proven actions that intend to make the system safer for future patients."

Nebeker and others also wonder what to do about the "lesser" harms that keep patients in the hospital longer and may impair a patient's future function, without rising to the "sentinel" level. "That's happening more frequently than sentinel events. Maybe by 1,000 times."

It's a simple fact that bad things can happen and it may not be someone's fault, numerous health experts told the Morning News. A hospital's procedures may increase the chance a patient will be harmed by an unexpected reaction to medicine, for instance. And mistakes are part of being human.

Rather than tackle those one at a time or try to blame an individual, safeguard-builders say they go after "system failures" that contribute to lots of harm. That's led to a proliferation of tools, from pharmacy robots and bar codes to electronic medical records.

"It usually speaks to process rather than human error," says Christopher Nelson, spokesman for University Hospital. "And the more adverse events reported, the more chance to look at these things and really investigate the root cause. Nine times out of 10 it's a process rather than a person, and we can make corrections."

But only, Utah safety experts add, if you know about them.

An IOM patient safety report laid out a plan for capturing and curing medical harm: Find every case that might have had an adverse event associated with care. Analyze it in detail. And classify it and store it in a database so "people can start to come up with clever ways to make care safer," says James.

Fear of lawsuits makes some practitioners leery of mentioning things that might have gone wrong. "That is a barrier to even more rapid improvement. ... The fear suppresses information," Michael Silver, director of scientific affairs and patient safety for HealthInsight, says.

Silver's among those watching avidly the baby steps to creation of what's being called enterprise liability, a kind of no-fault insurance to compensate patients who are harmed.