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Patient safety is no accident

Over the weekend, my eight-year-old son was speeding his bike down the hill in front of our house and ran his bike firmly into our garage. Fortunately, my son was uninjured and continued racing around the neighborhood despite the highly visible tread marks on the front of our house.

As you can imagine, my wife and I went into full-on reactive mode – Were you hurt? Was anyone else hurt? Did you hit your head? Were you wearing your helmet? Were the brakes working? Were you paying attention? Were you showing off for your friends?

In short, my wife and I were focused on safety in terms of “the absence of accidents or incidents” as the ideal state and “that things go wrong because of identifiable failures.” This view on safety, as defined by Erik Hollnagel, Robert Wears, and Jeffrey Braithwaite, is referred to as Safety-I. Safety-I is a linear, cause-effect view of safety that attempts to distill safety into its elemental parts to simplify analysis, planning, and prevention of future unsafe events.

Healthcare is complex

Although we prefer to understand safety events in terms of cause and effect, it is often not that simple. This is especially true in healthcare. Not only is healthcare complex, but its complexity grows every day. Just consider the number of variables at play — patients are sicker, technology is pervasive and more complex, doctors and nurses are required to do more with less — and you may wonder how we ensure patient safety as frequently as we do.

This perspective on safety, Safety-II, focuses not on what goes wrong but on what goes right to ensure safety. As defined by Hollnagel, et al, Safety-II is a “system’s ability to function as required under varying conditions, so that the number of intended and acceptable outcomes is as high as possible.”

Proactive Safety

While a Safety-I view focuses on safety reactively (i.e., identify and fix a problem), the Safety-II view focuses on safety proactively (i.e., focus on what usually goes right, what could potentially go wrong, and create a system that supports both). It is from the Safety-II perspective that we get the commonly heard phrase that “safety is no accident.”

Although different approaches to safety, Safety-I and Safety-II are not incompatible. In reality, they are complementary and are both required to ensure safety in whatever we do — riding a bike, driving a car, building a house, or caring for a sick patient in the intensive care unit (ICU) to name a few.

Allscripts Commitment to Safety

Allscripts has long developed health IT (HIT) solutions that improve the safety and quality of patient care. Equally important is our focus on ensuring our solutions work as intended (Safe HIT) and that human factors are incorporated into all aspects of solution delivery (Safe Use of HIT).

To achieve these goals, Allscripts partners with safety experts across the industry to learn best practices and incorporate them into our own safety process. Our most recent efforts to improve patient safety involve a shift upstream in the development process. By evaluating enhancements proactively to identify potential safety hazards, teams can mitigate or eliminate these risks to patient safety before they could ever reach a hospital, doctor or patient.

With an approach that embraces both the Safety-I and Safety-II views on achieving system safety, Allscripts continues to strengthen its commitment on making our solutions safer for patients, more usable for our clinicians and more effective at addressing the critical needs of our clients.

MORE: Listen to our three-part podcast series with experts from the ECRI Institute.

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