Resilient health care: turning patient safety on its head

TLDR

The current Safety‑I model relies on a post‑event find‑and‑fix approach, yet healthcare is complex and resilient, with clinicians routinely adapting to succeed more often than they fail. The study advocates shifting focus to Safety‑II, aiming to increase the frequency of successful outcomes rather than merely preventing failures. The authors propose proactive safety management that enhances clinicians’ flexibility and capacity, emphasizing improvement of everyday performance success over preventing occasional failures.

Abstract

The current approach to patient safety, labelled Safety-I, is predicated on a 'find and fix' model. It identifies things going wrong, after the event, and aims to stamp them out, in order to ensure that the number of errors is as low as possible. Healthcare is much more complex than such a linear model suggests. We need to switch the focus to what we have come to call Safety-II: a concerted effort to enable things to go right more often. The key is to appreciate that healthcare is resilient to a large extent, and everyday performance succeeds much more often than it fails. Clinicians constantly adjust what they do to match the conditions. Facilitating work flexibility, and actively trying to increase the capacity of clinicians to deliver more care more effectively, is key to this new paradigm. At its heart, proactive safety management focuses on how everyday performance usually succeeds rather than on why it occasionally fails, and actively strives to improve the former rather than simply preventing the latter.