Jeffrey P. Brown, M.Ed., is a principal at Safer Healthcare in Belfast, Maine

System-based safety management is slowly gaining ground in health care, but its reach must be broadened. From a systems perspective, adverse events arise from the unanticipated effects of interactions among people, technology, process, environment and organization — the major components of socially and technically complex systems. Safety is achieved or lost depending on how well providers and patients are supported in identifying and addressing sources of emergent risk and strengths of practice. A focus on improving system-based approaches to safety management could greatly accelerate our progress in patient safety.

Measures of patient safety must become more meaningful and less (unwittingly) deceptive to the public. As it is now, a hospital’s ‘A’ safety rating reveals that it can manage reported measures of safety, but not its ability to manage risk and safety. Prospective patients might assume two facilities that earn ‘A’ ratings are equivalent, although only one may meaningfully attend to unsafe conditions that are not measured as part of achieving that grade. We need to move from weak proxies for an organization’s “safety health” toward measures and ratings that reveal the relative power of an organization’s philosophy and methods for safety management, which operate in the background, invisible to the public.

We also need to focus on safety outside the hospital. Although the risk of preventable harm or death associated with inpatient care is well documented, little has been done to understand and mitigate the risk of accidental injury and death in ambulatory care. The health of individuals and populations is shaped primarily by conditions and circumstances beyond the walls of inpatient and outpatient facilities. A focus on ambulatory patient safety and its tangled relationship with social risk factors, lay care, and self-care is overdue.

Ultimately, as a society, we need desperately to overcome ideological barriers to investing in individual and population health. We need to develop efficient care delivery models that can mitigate the risk of patient harm and reduce the cost of care. It’s well past time to get “pound wise.”