The report “To Err is Human: Building a Safer Health System” is often considered a turning point in the history of patient safety, raising alarm both about the volume of “preventable” medical errors, and the state of safety management in healthcare relative to other industries. The report called for the adoption of a wide range of practices from other industries, in particular aviation, ranging through incident reporting and investigation policies, team training methods, management systems, and structured risk assessment methodologies.
‘To Err is Human’ exemplifies a phenomenon that to me is quite remarkable. Healthcare – one the best educated, professionalised skeptical and evidence-based domains – is willing to set aside its usual standards of critical thinking when adopting practices from other industries.
In this talk, Dr Drew Rae makes the argument, illustrated with examples from projects across a range of industries, that to a certain extent safety problems are universal, with patterns repeating across domains. However, he will also present some reasons to believe that the problems are exacerbated rather than improved by the uncritical adoption of safety ‘solutions’ between industries.
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