Systematizing Safety: The Urgent Need for Integrated Safety Management Systems in Healthcare

Carl Macrae (University of Nottingham), Systematizing Safety: The Urgent Need for Integrated Safety Management Systems in Healthcare (2022):

Patient safety remains a difficult and persistent challenge for healthcare organizations around the world. Despite enormous effort and considerable investment over the past several decades, frustrations are rising at the limited progress that has been made. One of the most striking features of the past few decades of effort to improve patient safety is the isolated and individuated character of much of this work: the field has blossomed with separate interventions, stand-alone programmes, discrete processes, individual roles, and distinct policies. This blooming of a thousand flowers across the field is indicative of the creativity and experimentalism that has been brought to bear on the problem of patient safety. But it is also indicative of something much more troublesome: fragmentation and—in its most literal sense—disintegration characterise many approaches to patient safety, both within individual healthcare organizations and across entire healthcare systems. What has long been missing—and what healthcare organizations and regulators urgently need to develop—are carefully structured and reliably implemented safety management systems in which all safety-relevant functions, activities, priorities and accountabilities are tightly integrated, properly resourced and coherently organized so that every potential source of harm and risk (and all sources of safety and resilience) can be proactively managed in each care setting across a healthcare system. This paper explores the challenge of what integrated systems of safety management should look like in healthcare and how we should get there. Three areas help point the way: other safety-critical sectors that have travelled this path before; emerging thinking and exploration in healthcare organisations; and the policy and legislative context that frames this journey. Each is considered in turn.