Safety in Healthcare

Safety-I is the traditional way of safety management, examining things that have gone wrong and creating measures to prevent it happening again. Safety-II takes another point of view, focusing on the things that go right to help eliminate errors. Putting it simply “Safety-I is minimising the bad and Safety-II is maximising the good”. Importantly Safety-II sees variation in human performance as an essential factor for success because reaction to variability is necessary, while Safety-I rather tends to restrict variability and focuses on error, or what is perceived as error.

The two perspectives on safety must co-exist. It is necessary to analyse the relatively few cases where things go wrong, but patient safety requires more than prevention, elimination and compliance. It is therefore essential to learn from the far more frequent cases where things go right and develop ways to support, augment and encourage these.

Changing the way we look at healthcare, embracing complexity, working with rather than against performance variability, and leveraging more of what we already have—a great deal of success in things going right—will take time and a willingness to shift the paradigm. But we must start to do things afresh.