In What Would You Do with JACHO you asked for my opinion on what might be dome to improve JCHAO's effectiveness at promoting patient safety. A very complicated question, because it speaks to the issue of changing culture, whether it be acceptance of hand washing among hospital workers, the loss of acceptability of the use of public racial epithets, or the end of foot binding after a thousand years of practice. I'm not a social scientist, and even I were I'm sure the convergence of social and political forces that lead to these sea changes would defy any simplistic causality. While political pressure generated outside the affected group may help, the impetus for change often comes from some courageous figure or members within the group itself.
The other basic element appears to be sunlight. While I make sure to wash down my daily dose of liberal media with a chaser of healthy skepticism, I have no doubt of the essential function a free and spitited press plays in promoting change. Shame after all is a wondeful motivator.