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Hospital care is unavoidably associated with the risk of preventable harm due to human error. The problem is pervasive, damaging and expensive - globally, and in New Zealand (NZ). But while many of the processes through which patients are harmed have been described, there is a lack of published research about the perspectives of staff in public hospitals in NZ on patient risk. This article reports on a qualitative investigation of how nurses, doctors, and managers in NZ understood patient harm. Their perspectives, analysed here through theory about risk in complex systems, emphasised economically-driven pressure as an important risk factor that dominated safety.