Perioperative safety: it's time to drop our tools

In the quarter of a century since the release of the report To Err is Human, current progress in patient safety is at best inconsistent, and at worst, has outright stalled. To resume the speed of progress made at the start of the patient safety movement, we will need to approach patient safety in a different way.

The lack of progress in patient safety has increased enthusiasm for different paradigms of understanding patient safety. Rather than focusing on deficit-based models of patient safety, newer approaches focus on complementary methods that attempt to understand the essential underpinnings of work that is safe.

Weick describes the story of wildland firefighters who failed to drop their tools when they were no longer useful, resulting in their deaths. While the tools used by patient safety professionals are not physical implements, a similar phenomenon exists. In this review, the commonly used patient safety tools which are impeding progress are discussed. Alternative views to citing human error as a cause, ruthlessly targeting unachievable goals, and approaching the complex environment of healthcare as a linear system are presented.