Safety
The working draft of the Tavistock principlespublished in 1999 had only five principles.This sixth onewas added as a result of consultation (and the seventh was addedafter discussion at the April meeting). Initially there was anxietyover "do no harm" because it is so strongly associated with doctors.But it seemed important to include because there is increasingrecognition of just how much harm healthcare systems produce andof how policies with benign intentions can createharm.

"Do no harm," however, is impossible to achieve, pointed out Uwe Reinhardt, professor of political economy at Princeton University,and John Eisenberg, director of the Agency for Healthcare Researchand Quality in the US Department of Health and Human Services.All effective interventions may harm, but the intention behindthe principle is not that practitioners should never make an intervention;it is that they should struggle to maximise benefit, minimiseharm, and reduce error.

Openness
This last principle might be both the mostbanal and the most profound. Nobody could argue against beingopen, honest, and trustworthy, and yet every day in every healthcaresystem people fail on all three counts. It's difficult to be openand honest about deficiencies in your hospital or practice. There'salways a way to "soften the blow" or "be economical with the truth."You worry that you might lose the trust of patients or the public,yet nothing destroys trust faster than being found to havedeceived.