Safety II: A Novel Approach to Reducing Harm

Traditional safety efforts in healthcare have relied on learning from mistakes. This method (termed “Safety I”) includes error identification and reporting, investigation, and subsequent policy and procedure revisions if needed. Believing the Safety I approach can eliminate harm derives from evidence that standardizing work improves reliability and quality, which both affect safety. However, the Safety I approach has limitations due to the complexity of patients and healthcare delivery, making pre-planned, stable solutions to every possible situation impossible. Furthermore, as harm events become increasingly rare, there is less opportunity to learn from each occurrence, with events becoming “one-offs” unrelated to prior harm. Thus, if an organization’s goal is zero harm, the Safety I approach alone may be insufficient to reach that ambitious target. The solution may lie in a new approach – “Safety II.” The key philosophy of Safety II is that individuals and systems usually perform well, even under varying conditions. By understanding why things usually go right, even when they might not, and increasing the capability to handle unanticipated or unusual scenarios, patient safety will improve. Safety II leaders (psychologists, philosophers, systems and resilience engineers, and healthcare professionals) have proposed four highly interrelated activities believed to increase odds that systems will succeed during unpredictable conditions and improve outcomes: Monitor, Anticipate, Respond, and Learn. By using an illustrative case example, we will outline how Safety II practices can avoid harm in the healthcare setting.