Safety II Behavior in a Pediatric Intensive Care Unit

Area of Science:

• Pediatric critical care medicine
• Patient safety research
• Healthcare systems engineering

Background:

• Traditional Safety I approaches focus on error elimination by investigating past failures and redesigning systems.
• The Safety II approach emphasizes system flexibility and individual resilience to manage complex and unpredictable situations.
• High-risk environments like pediatric intensive care units (PICUs) can benefit from understanding how to proactively ensure safety.

Purpose of the Study:

• To investigate how Safety II concepts are implemented in a PICU with a low adverse drug event rate.
• To identify specific system characteristics and behaviors contributing to enhanced patient safety.
• To understand the interplay between Safety I and Safety II principles in a real-world clinical setting.

Main Methods:

• Multidisciplinary focus groups were conducted with PICU staff.
• Open-ended questions facilitated discussions on safety practices within the unit.
• Qualitative analysis of transcripts identified key themes and domains related to safety.

Main Results:

• Four key domains emerged: individual characteristics, relationships/interactions, structural/environmental factors, and innovation approaches.
• Themes from the first three domains aligned with adapted Safety I principles.
• Innovation approaches, specific to Safety II, were identified as crucial for managing unusual situations.

Conclusions:

• The PICU effectively integrates Safety II behaviors by adapting Safety I foundations with innovative strategies for unpredictable events.
• These combined safety approaches contribute to a low adverse drug event rate.
• The identified Safety II behaviors are teachable and learnable, with potential for broader organizational implementation.