Sharp End

The sharp end refers to the personnel or parts of the health care system in direct contact with patients. Personnel operating at the sharp end may literally be holding a scalpel (e.g., an orthopedist who operates on the wrong leg) or figuratively be administering any kind of therapy (e.g., a nurse programming an intravenous pump) or performing any aspect of care. To complete the metaphor, the blunt end refers to the many layers of the health care system that affect the scalpels, pills, and medical devices, or the personnel wielding, administering, and operating them. Thus, an error in programming an intravenous pump would represent a problem at the sharp end, while the institution's decision to use multiple types of infusion pumps (making programming errors more likely) would represent a problem at the blunt end. The terminology of "sharp" and "blunt" ends corresponds roughly to active failures and latent conditions.

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