Your thoughts about "dual use" causing the Challenger accident is interesting. I wonder if this is one of the primary risk factors in situations where a high hazard industry fails to limit "production pressure", and safety concerns become increasingly subservient to efficiency.
Unfortunately, some element of "dual use" is the only thing currently on the agenda as a proposal in health care at the present time. Because we cannot show a significant improvement in patient safety in the last 12 years, the agency responsible for safety and quality research, called the AHRQ, is lobbying for increased regulatory authority. That would be like combining NASA and the FAA. Also, there is nothing on the agenda at the Federal level for feedback (no ASRP). Some specialties are starting their own reporting systems, but they are spotty and they are primarily set up for a "Callback" style newsletter, not as a means to improve regulation.
Finally, although various "rewards" are being tried to encourage "rule compliance", liability mitigation is not one of them. The "get out of jail" seems to be critical.
I am considering discussing Reason's "Swiss Cheese" model early in this article because from what I understand about the model is that the key to transforming an unsafe system to a safe system is to: "close the holes" in the Swiss cheese, and to build redundancy. Closing the holes requires feedback, and feedback requires infrastructure.
So it seems that to transform health care base on lessons from aviation, we need to avoid the "dual use trap", have feedback at the national and local levels, consolidate rule making, and have a reward system that mitigates liability. Feel free to disagree if I missed something.