The Next Phase for Patient Safety: Is it time to move beyond “Errors” and stop using the word “Safety”?

Ever since I started working with High Reliability Organization Safety Programs 36 years ago we have worked on how errors could be prevented and how managers could get their staff to consistently follow safety policies. However, in the last couple of years I have come to accept that “errors are normal” and “deviations from expected behaviors is normal”. Then, last month my perspective shifted further. While listening to the Pre-Accident Investigation podcast, I heard Dr. Erik Hollnagel tell Dr. Todd Conklin that we should “get rid of the word safety”. Having just done a presentation on the new “Safety II” concepts, this was not a shock to me. Hollnagel is a critic of the typical safety program focus on negative events and reacting to conditions and behaviors after they affect outcomes. The Safety II approach calls for a proactive emphasis on improving system performance.
A lot of the activities initiated in response the Institute of Medicine report in 1999 included citing the number of deaths due to medical errors and creating new policies on patient safety. Unfortunately, at the time; the word “error” was immediately associated with punishment, “safety” was primarily associated with falls and incident reporting programs were part of the malpractice risk management program. Not surprisingly one of the main obstacles was the natural defensiveness and denial that occurs when someone is told they are part of a group responsible for 98,000 deaths per year. With Safety II, there is a more positive emphasis on behaviors that can improve current systems. So maybe it is time to focus less on errors?
Regarding the use of the word “safety”, anyone who has sought budget and full-time employee resources for safety programs knows these financial requests are prioritized below requests for operational initiatives that are designed to increase “production”. Also, anyone who does many Root Cause Analyses (RCAs) eventually learns that the causes of almost all events can be traced to the culture of the organization. My experience has been that a well-managed organization will usually be safer, more cost effective and have better morale. These organizations don’t rely on a Chief Morale Officer or a large Safety department. Safety, cost effectiveness and morale are all outcomes of a learning organization. In other words, we should stop focusing on errors and adding safety program requirements and instead concentrate on continuously improving system performance.
What do you think?