Intermountain and the University Healthcare System, Columbia hospitals and others are using high-tech tools to help spot problems.

But a community that already doesn't understand the issues needs to be warned. The reported injury rate will skyrocket, James predicts, and it will look like things are getting a lot worse, when in fact they're simply being counted.

Take clinical triggers nationwide and report what you find, he cautions, and it will be "ice water down your back. It would be breathtaking. And we'd all go through a period of denial. But when we get through that, we are good at coming together to work on these things."

Not everyone's convinced that keeping the public in the dark is the best approach. But critics of public disclosure worry someone will take the numbers at face value and not realize what they mean, which might be that a facility that looks safety-challenged is the one seriously tracking problems they all have but most are not owning up to or perhaps even recognizing.

Most patients wouldn't look at the numbers if they were public. They make decisions about where to seek treatment based not on safety stats or sentinel events but on where their physician has privileges or where their insurance will pay, says Nebeker. The institutions themselves, however, do pay attention to patient harm data.

"What we want is an open environment, where (care providers) get into the routine of reviewing so problems can be fixed," says Jill Vicory, Utah Hospital and Healthcare Association (UHA) spokeswoman. "It's a very personal thing when there's an accident or you harm a patient, so we need to keep it open and not be guilt-based. ... Having said that, it may be time to revisit it and make sure we are getting everything reported."

Adds Deb Wynkoop, UHA safety pro, "I don't think hospitals are against public reporting; they just want to make sure it's good science and the data is valid."

Utah's health care providers and public health officials say Utah is making care safer for patients, whether it's apparent or not.

In the adverse drug event arena, user groups formed of hospital representatives are targeting anticoagulants and insulin, where mistakes can cause great harm. Hospitals use computer programs to look at interactions and doses. The VA and others are part of a project that combines triggers and clinical care to "identify patients who have harm that we can intervene on," Nebeker says. And they want to figure out a way to help smaller, cash-strapped hospitals get the technology they need to use the triggers.