Wherever you work in healthcare and whatever role you have you will be wanting to ensure the safety of the patients in your care. You will want to find ways of building safety within your work. However, healthcare is an uncertain world and the difference between safe care and unsafe care can be decided in minutes. Over the last two decades and more we have tried hard to prevent things from going wrong, to detect them quickly if they do, to limit the harm as much as possible and to learn for the future.
Today though, we are asking, why are we not as safe as we should be, given the amount of effort we have put into the science of safety over the last two decades? This question has led to further questions about the approach we have taken in healthcare and the tools we have used to date. Reflection and critique of our approach to date by those that work in safety have highlighted a number of misunderstandings and myths but also a potential way forward. As a result, some have asked, why do we simply focus on the things that go wrong and why do we not focus on the times when we get it right in order to understand how safe we are?
Safety-I and safety-II has been coined by Erik Hollnagel. I was enthralled by this concept when I heard Hollnagel present it over five years ago now. I do not purport to be an expert but ever since I have been exploring with others what people think about it and how people think we could apply it to healthcare. During this time a few other concepts have grown in stature; restorative just culture and psychological safety to name just two.
The goal of my latest book, Patient Safety Now, is to help the reader understand this new way of thinking about safety; safety-I and safety-II together with these other emerging concepts. I hope it helps equip you with knowledge about the new ideas and practices that could help enhance people’s ability to work safely. No matter what your job or role is at your workplace I hope that you will find this book useful in helping raise awareness about the latest concepts but also to change the conversations, methods and processes related to safety in your organisation.
It is written from the viewpoint of safety in the National Health Service (NHS) in England but hopefully will resonate wherever healthcare is provided. I have in the main deliberately used the word safety throughout this book rather than patient safety in order to reflect the importance of safety for both patients and staff.
Anyone who works in safety should not be made to feel that the work they have done to date has been a waste of time. This is not what this book is about, although it may not feel like that. I recall reading still not safe and feeling guilty that I had been part of it all, that I had perpetuated the way in which we do safety. I had promoted incident reporting as the way to find and fix things, and I had promoted root cause analysis as a way to really find out the causes of incidents. I had made all kinds of things seem too easy to do ‘simply build a safety culture’. Easy. None of this is easy.
Where we are today has been built on all the learning, we have done over the last two decades, none of which has been a waste of time. It has helped forge our understanding of what has worked and what hasn’t, it has provided us with a depth of experience that will help us figure out what the future looks like. That’s what learning is, it is emergent and clarified over time. Make sure that the new knowledge we gain is built on the old knowledge. The more we do things, the more we know, for better or worse. Value what you have done while thinking about where we can take safety into a different direction.
PATIENT SAFETY NOW 