Two recent books about how hospitals are organized illustrate the essential tension over a fundamental dynamic of society. Safety in Numbers argues that an indispensible element of hospital patient safety is mandated nurse-to-patient ratios and that those will be achieved only when nurses force the change on hospitals. Hospital, on the other hand, is a journalistic account of one hospital; while acknowledging elements of conflict, it suggests that shared vision and workplace bonds are what hold together at least this particular hospital. What emerges from both works is a sense that the business of operating hospitals tends to be a very human one that typically achieves results through rather messy processes. These lines of thought are crucial as the nation contemplates what it really wants in its health care system—and how on earth to achieve it.

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