Viewpoint threats of compulsory licensing. 16 30 Such moves are not uncontested, nor is their effectiveness assured. 32 Yet they represent an important expansion of oppor- tunity for reform—an opportunity whose potential will rest, in part, on the collective engagement of the healthcare community CONCLUSION Many of the policy and system issues that bear on medical product supply are not traditional areas of concern for the healthcare quality community. Quality improvement teams may take aim at medication administration errors due to poor labelling but not the shortage-induced use of unfamiliar products that contribute to such errors. They may target delays in care due to poor scheduling but not delays that arise when needed products are simply not available. Quality improvement teams may not lack interest, but they will often lack leverage. Individual clinicians and care organisations can anticipate shortages and mitigate their harms once they arise (eg, the Amer- ican Society of Health-System Pharmacists’ Guide- lines on Managing Drug Product Shortages), 33 but their capacity to prevent such shortages is inherently limited. Resilient sourcing strategies offer some reme- dies—sourcing from multiple vendors, securing local supply and maintaining inventory. But demand side strategies can only do so much. As with the persistent neglect of human factor issues in medical device design, many solutions necessitate ‘controlling the supply side’ at macroscale. 34 The pandemic may have made some of these controls more possible, but there are few easy solutions to systemic patient safety chal- lenges. As with addressing any quality problem, the first step consists of recognising and understanding the contributing factors and system issues. The next lies with assuming a shared responsibility in developing effective solutions. Contributors FM and KGS conceived the idea for the paper. FM drafted the manuscript. All authors contributed to manuscript revisions. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained. ORCID iDs Fiona A Miller http://orcid.org/0000-0003-4953-6255 Kaveh G Shojania http://orcid.org/0000-0002-9942-0130
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