'Primum non nocere' - The old lie?

Area of Science:

• Healthcare Management
• Patient Safety
• Systems Engineering

Background:

• Despite two decades of patient safety initiatives based on the Safety 1 paradigm, significant improvements in hospital patient harm rates (10%) have not been achieved.
• Modern hospital medicine operates within complex, intractable systems, necessitating new approaches beyond traditional safety models.
• The Safety 2 paradigm highlights the 90% of times when healthcare functions effectively due to clinicians' adaptive capabilities.

Purpose of the Study:

• To evaluate the limitations of the traditional Safety 1 paradigm in contemporary healthcare.
• To propose a hybrid approach combining Safety 1 and Safety 2 paradigms for enhanced patient safety.
• To address the need for adaptive safety strategies in complex hospital environments.

Main Methods:

• Review of existing patient safety frameworks, specifically Safety 1 and Safety 2 paradigms.
• Analysis of the evolution of hospital medicine and system complexity.
• Conceptual integration of Safety 1 (for simple events) and Safety 2 (for complex, adaptive situations) principles.

Main Results:

• The Safety 1 paradigm remains relevant for addressing simple adverse events.
• A significant portion of healthcare operates successfully due to clinician adaptation, aligning with Safety 2 principles.
• A combined approach is necessary to manage the spectrum of patient safety challenges in hospitals.

Conclusions:

• A hybrid Safety 1 and Safety 2 approach offers a more effective strategy for improving patient safety in complex healthcare systems.
• Recognizing and leveraging clinician adaptability (Safety 2) is crucial alongside traditional error prevention (Safety 1).
• Future patient safety efforts should integrate both paradigms to address diverse risks and enhance overall system resilience.