• Curr Probl Pediatr Adolesc Health Care · Dec 2015


    Safety-I, Safety-II and Resilience Engineering.

    • Mary Patterson and Ellen S Deutsch.
    • Division of Emergency Medicine, Cincinnati Children's Hospital, Cincinnati, OH. Electronic address: Marydpatterson84@gmail.com.
    • Curr Probl Pediatr Adolesc Health Care. 2015 Dec 1; 45 (12): 382-9.

    AbstractIn the quest to continually improve the health care delivered to patients, it is important to understand "what went wrong," also known as Safety-I, when there are undesired outcomes, but it is also important to understand, and optimize "what went right," also known as Safety-II. The difference between Safety-I and Safety-II are philosophical as well as pragmatic. Improving health care delivery involves understanding that health care delivery is a complex adaptive system; components of that system impact, and are impacted by, the actions of other components of the system. Challenges to optimal care include regular, irregular and unexampled threats. This article addresses the dangers of brittleness and miscalibration, as well as the value of adaptive capacity and margin. These qualities can, respectively, detract from or contribute to the emergence of organizational resilience. Resilience is characterized by the ability to monitor, react, anticipate, and learn. Finally, this article celebrates the importance of humans, who make use of system capabilities and proactively mitigate the effects of system limitations to contribute to successful outcomes. Copyright © 2015 Mosby, Inc. All rights reserved.

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    This article appears in the collection: Reducing health-system harm: Safety I vs Safety II.


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