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Introduction
Patient safety is a growing concern among healthcare professionals and the public. Studies range from critical reports on patient care and quality to calls for more empirical evidence to demonstrate improved safety ([1] Anderson et al. , 2006; [26] Gregory et al. , 2007). Increasingly, however, researchers are recognizing that the context in which healthcare is provided is a critical perspective that is lacking patient safety discussions ([42] Mwachofi et al. , 2011; [51] Pronovost et al. , 2006), which includes understanding organizational culture, communication failures, degree to which an environment is conducive to change and more importantly, workers' ability to learn from preventable adverse events and to view these as learning opportunities ([27] Hellings et al. , 2007; [47] Odwazny et al. , 2005). It has been suggested that developing a learning organization could result in improved patient safety yet very little empirical research has examined the learning organization concept and patient safety. Our objective, therefore, is to review the relevant literature on patient safety culture, organizational learning, teamwork and collaboration, develop and propose a conceptual framework that links these concepts. Such a multi-factor conceptual framework is necessary for a more holistic way of viewing patient safety. Some potential research questions are posed based on this conceptual model, which can help to increase our understanding, improve patient safety culture and outcomes.
Patient safety research
Patient safety researchers have increasingly noted that the current approach to improving patient safety has produced less than satisfactory results. In fact, progress has been disappointing at best as indicated in the 1999 Institute of Medicine (IOM) report: To Err Is Human ([31] Kohn et al. , 2000), which indicates that 45,000 to 98,000 Americans die each year from preventable medical errors. In Canada, the "Canadian Adverse Events Study" shows that 7.5 percent of hospital admissions (approx 185,000 each year) suffer an adverse event and that approximately 70,000 (38 percent) are preventable ([3] Baker et al. , 2004). There have been attempts to establish safe and reliable systems that patients and health providers deserve ([41] Moumtzoglou, 2010). Initiatives include regulations, new reporting systems and measures, information technology and malpractice systems ([42] Mwachofi et al. , 2011). However, all these had minimal impact and are cause for concern ([38] Longo