Understanding patient safety performance and educational needs using the 'Safety-II' approach for complex systems

Area of Science:

• Healthcare Systems Analysis
• Patient Safety Research
• General Practice Training

Background:

• Patient safety initiatives are crucial for general practice (GP) specialty training, appraisal, and revalidation.
• Current safety methods often use a 'find-and-fix' approach, which may not fully address complex healthcare system interdependencies.
• The Royal College of General Practitioners' curriculum outlines patient safety training priorities for GPs at all career stages.

Purpose of the Study:

• To explore the Safety-II approach as a novel framework for understanding and enhancing patient safety in general practice.
• To evaluate how Safety-II can improve quality and safety initiatives and enrich GP and trainee curriculum coverage.
• To investigate the potential benefits of managing variability, rather than solely constraining it, in healthcare systems.

Main Methods:

• Reviewing the principles of the Safety-II approach in the context of complex healthcare systems.
• Analyzing how Safety-II focuses on 'work-as-done' and everyday successful outcomes.
• Considering the application of Safety-II to incident investigation, quality improvement, risk analysis, and performance indicators.

Main Results:

• The Safety-II approach emphasizes maximizing successful outcomes by examining everyday work, acknowledging that 'work-as-done' often deviates from protocols.
• Understanding and managing variability within healthcare systems may be more beneficial than traditional methods that aim to constrain it.
• Applying Safety-II principles could provide deeper insights into system performance, leading to more effective patient safety changes.

Conclusions:

• The Safety-II approach offers a valuable alternative or supplement to traditional safety methods in general practice.
• Integrating Safety-II principles into incident investigation and quality improvement can enhance understanding of system dynamics.
• Combining Safety-II with traditional methods is a promising strategy for advancing patient safety training, outcomes, and curriculum development in GP.