The systems approach at the sharp end

A systems-based approach to patient safety has been widely accepted and advocated. Despite this, and a renewed -emphasis on organisational learning in improving the safety of patients, many patients still suffer unintended harm during their care. This paper reviews the central theoretical themes of a systems-based approach and raises four key questions -relating for clinicians working at the 'sharp end': how can -clinical teams best apply a systems approach to patient safety, how can patient safety move from a focus on past harm to a proactive approach, how can we avoid a corrosive culture of blame, and what should our response at the sharp end be to seemingly unsolvable problems?