Design for Safety and Resilience: Looking Underneath the Safety-I and II Labels

Ten years ago, Safety-II was introduced as a new approach to safety and contrasted with the existing approach (Safety-I), which emphasized learning from work as done in practice and the adaptive capacity of professionals who manage to deliver safe care in challenging circumstances. While Safety-II was presented as a complementary view of safety, it remained unclear how the 2 approaches would complement each other in daily practice. The aim of this paper is to reexamine the Safety-I and II distinction, look beneath the 2 labels to understand what complementary safety approaches can be distilled and how and when each safety approach might be used in practice. The Safety-I and II labels do not clearly convey the critical distinction between safety approaches, which may be part of why implementation in practice has been challenging. We suggest that the critical distinction is between "designing hazards out of the system" versus "relying on adaptability and resilience of the system," which does not equate to Safety-I and II. This distinction makes it clearer when each approach should be used in practice, that is, in normal circumstances or when dealing with unexpected disruptions, and how well-known safety strategies fit either approach. We should focus on designing systems that support human work while also enabling any necessary adaptations to enhance care. Resilience should not be a crutch for poor system design, but a deliberate response when systems are stretched.