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Int J Qual Health Care. 2015 Oct;27(5):418-20. doi: 10.1093/intqhc/mzv063. Epub 2015 Aug 20.

Resilient health care: turning patient safety on its head.

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Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
Department of Emergency Medicine, University of Florida, Jacksonville, FL, USA Clinical Safety Research Unit, Imperial College London, London, UK.
Institute for Regional Health Research, University of Southern Denmark, Odense, Denmark Center for Quality, Region of Southern Denmark, Middelfart, Denmark.


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.


Safety I, Safety II; health system reform; human factors; patient safety; resilient healthcare

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