Patient after patient asks for relief for sinusitis. Doctor after doctor gives them a prescription for medication-even though most infections are viral, not bacterial, needing no drugs to treat.

It is easy to say that patients are at the center of healthcare, but a challenge healthcare leaders face centers on the question of responsibility for the patients' care. Some providers are evaluating the patients' role, committing resources to help educate them as to their central place in healthcare. Others are still struggling to understand the impact of patient-centered approaches.

Something went very wrong a few years ago when ­Michelle Malizzo Ballog underwent surgery to replace a temporary stent in her liver at the University of Illinois Medical Center (UIMC) in Chicago. Tim McDonald, MD, chief safety officer, says he remembers vividly the text he received from a nurse as Ballog stopped breathing: Come quick. Things going badly. Cardiac arrest.

Health insurance exchanges will shake up the healthcare system, and physician practices will feel the effects directly in their managed care contracts and reimbursement. Don't be misled by the fact that the big impact from exchanges won't happen until 2014, because now is the time to influence how the systems are designed and soften the blow to your practice.

Dave Gans thinks every physician group needs to be an HRO-a high-reliability organization. HROs handle emergencies well because they recognize danger signals and respond in such a way that their systems continue to function and catastrophic outcomes are avoided.

Physician groups looking to be more efficient should develop patient safety lists that address emergent events and routine activities, according to Elizabeth Wertz Evans, RN, executive director of professional practice for the Oncology Nursing Society in Pittsburgh.