As part of the ongoing ‘The problem with’ series in BMJ Quality & Safety, a recent article by Merel Verhagen and colleagues explore ‘making Safety-II work in healthcare’. In the article the authors provide a helpful summary of what Safety-I and Safety-II is, which includes ‘What Safety-II brings to the table’. However, the section titled ‘Bringing Safety-II into practice in healthcare: Challenges and Opportunities’ is where to real meat of the paper lies.
Here the authors grapple with the challenges for event analyses, i.e., ‘how we move from descriptions to interventions’, the challenges for learning, i.e., ‘how to learn from everyday work rather than negative outcomes’, and the challenges due to the ‘lack of validation studies and evidence for effectiveness’: “Even though FRAM analyses have been carried out in a wide range of setting, these studies often struggle to demonstrate that the studied processes have actually been improved”. The examples of patient safety initiatives which are approached from the Safety-II perspective is a helpful hint at how alternative insights could be garnered.
In conclusion the authors state that “Safety-II offers a distinct perspective on patient safety by accentuating the importance of understanding the uncertainties and trade-offs in everyday work, with its successes and failures. Its potential value lies in providing a deeper understanding of the abilities that serve to create safety, and ways to strengthen these in closer alignment with the complexity of everyday ‘work-as-done’. However, challenges with the concept’s credibility, practicality and scientific evidence base hamper its adoption in healthcare.”
There is an ongoing debate regarding the reduced focus on patient safety in healthcare at the moment – as espoused by Torben Mogensen and Beth Lilja in Dagens Medicin, and discussed by Henning Boje Andersen at the recent Patientsikkerhedskonferencen. We consider this paper a useful contribution to this debate as it highlights potential reasons why the focus may have reduced and what strategies could rectify the problem.
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Verhagen MJ, de Vos MS, Sujan M, et al The problem with making Safety-II work in healthcare BMJ Quality & Safety 2022;31:402-408