'Primum non nocere' - The old lie?

Harm occurs in 10% of hospitalised patients. After 20 years of patient safety implantation plans using a Safety 1 paradigm, developed from high-risk industries, there has been no significant change, except in certain niche areas. Hospital medicine has changed over the last two decades; we now work in an intractable system. The Safety 2 paradigm looks at how things go right (90% of times) so often. Clinicians are able to adjust their work to conditions (work as done) and adapt to changing conditions. Therefore, the way forward, is a combination of these two paradigms. It is still the case that some of these adverse events are relatively simple or can be treated as relatively simple without serious consequences. Using a Safety 1 paradigm will therefore be appropriate. But there is a growing number of cases where this approach will not work. In these instances, it is necessary to adopt a Safety 2 view.