Utah hospitals and surgical centers have adopted a uniform way of marking the correct surgical site. The patient, if capable, is asked to write "yes" on the body part that's being fixed. That came after the very limited reporting showed that 21 percent of sentinel errors were wrong-site surgeries.

Another group is tackling pressure ulcers and surgical-site infections.

Individual hospitals are changing their routines. At St. Mark's Hospital, for instance, patients who are about to undergo certain types of surgery are tested to see if they carry bacteria that can lead to specific infections. If so, they get antibiotics early on.

Says the VA's Nebeker, "It's probably safe to say everybody has made some progress."

Still, reporting is clearly inadequate. When even enticements can't bring answers, patient safety advocates are looking for something that does. One unusual "carrot" is being floated: There's talk nationally of a safety "seal of approval" modeled after one created by the College of Surgeons. Every three years, independent auditors would pore over a facility's list of patient harms to see that occurrences are being traced and safety measures implemented.

They'd be the medical field's equivalent of certified public accounts, a field James credits for much of what works well in corporate America. They root out corruption in the financial world, where the definition of transparency was born.

If Utah did create a system where sentinel events are reported, the information transparent to the public, there are still things it won't do. It won't prevent things that are missed or the judgment calls that are simply wrong. It won't change what happened recently to a Utah man who was sent home from an emergency room with "bursitis," only to be hospitalized the next day with what was actually a life-threatening infection. It won't prevent a Utah woman's search for a cause of her fatigue, finally diagnosed and treated years later. Those are both cases reported to the Deseret Morning News by readers recently.

"The thing we're missing is the near misses, or near hits," Wynkoop says. "I think that's what we may not be doing very well. We could definitely do some improvement by enhancing communication among the entire health care system."

And despite strides in making hospitals safer, James emphasizes there's a long way to go. He likes to quote one of his colleagues in the field, who quips that, with all the improvements, "we're still the cream of the crap."

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E-mail: lois@desnews.com