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The Safety-II approach: Learning from what goes well

Updated at: 31 January 2024
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What is the safety 2 (II) approach in healthcare?

Safety II is a modern patient safety initiative that focuses on what’s going well in a system or process. Consider that in 98% of cases, a system and the people, processes, equipment, software, etc., within it function well and do what’s intended. Yet most safety approaches focus on the 2% of cases that don’t deliver the desired results based on their design. It seems more efficient, then, to focus on the things that are going well. But how can we manage and learn from the absence of incidents in an organization

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Safety-I vs. Safety-II and a new way of thinking

The Safety-I approach

The Safety-I approach is used to report on and analyze (near) incidents and calamities by examining failures in a system. Safety-I assumes that processes are predictable, so that when a link within a process fails, the causes can be identified and analyzed. Using this approach, Incident Reporting Committees look at a sequence of events and establish the logical link(s) between the incident and its root causes. In this way, the origin and course of the incident or error become transparent, enabling us to learn from it and ultimately improve processes.

The origins of the Safety-II approach and how it differs from the Safety I approach

Representing a new way of thinking, Safety-II starts by looking at daily practices—not at the design of the guidelines, processes, and protocols. The analytical method used in Safety-II originally stems from the technical sector, and was first used in aviation and construction before it was adopted for use in healthcare.

Safety-II and FRAM provide insight into human factors

Safety-II informs us that we cannot manage safety and improvements if we don’t know the specifics of how things work in practice. Healthcare is like other industries in that it follows stringent guidelines and protocols. But the practice of healthcare is complex and consists of many different dynamic processes that impacts patient safety.

>> Learn more about patient safety on our Patient Safety topic page.

One important variable is the human factor, often the reason that guidelines and protocols cannot always be uniformly implemented. Every patient, client, and practitioner is different and therefore approaches each situation differently. For example, some patients may be more nervous and therefore require more of a practitioner’s time to prepare for an operation.

A perfect match to the FRAM method

This key premise of Safety-II makes it a perfect match to an analytical method called Functional Resonance Analysis Method (FRAM) (prof. Erik Hofnagell - 2017). The goal of FRAM is to map work as it is accomplished within the daily reality of the workplace.

The FRAM method takes into account people’s routines, customs, and habits. It map both risks and best practices within the system based on these daily workplace factors. The method is also in line with the philosophy of Appreciative Inquiry (AI) (appreciative research), in which the stimulation of what goes well in the workplace is the starting point.

How is Safety-II connected with agility in organizations?

Committed employees make your organization stronger. Not only because they are more agile, but also because they are more likely to report incidents when things do go wrong. Download our eBook 'Staff Commitment' about increasing the motivation of healthcare professionals.

Safety-II recognize that in modern systems, causes of errors or incidents are often multi-factoral and adjustments can lead to both desired and unintended/undesired outcomes. As a result, agility and resilience are desired qualities, both for organizations and their employees. Flexibility and resilience equate to a state of readiness to adapt to any situation instead of rigidly adhering to work processes and protocols (i.e., work as imagined).

The FRAM method provides insight into how professionals work together all day, under complex circumstances, and the ways in which they must adapt again and again. Analyzing how people and systems respond to unexpected and ever-changing circumstances helps us to create more adaptable organizations and aid individuals in becoming more resilient. That agility and resilience, in turn, can help create safer workplaces for all.

Visit our blog about FRAM for more information.