Lessons in safety that manufacturing got right—and what it means for patient voice in healthcare

Summary

In manufacturing a missed signal can cost a product, but in healthcare it can cost a life.  In this blog, Annette Cairns, a leadership development specialist, asks how we can adapt the system-level thinking seen in manufacturing for the unique human complexity, variability and vulnerability that patient care brings.

Content

In manufacturing, there was a moment—and you can trace it back through aviation, oil and gas and automotive—when the conversation about safety changed fundamentally.

It stopped being about finding the person who made the mistake, and started being about understanding the system that allowed the mistake to happen.

That change didn’t come easily or by any means quickly. It required organisations to accept an uncomfortable truth: that in complex, high-pressure environments, human error isn’t primarily a sign of individual failing. It’s a predictable consequence of how systems are designed, how cultures are shaped and how leadership behaves in the moments that really count.

The results, where that change has genuinely taken root, have been significant. Aviation is the most cited example—an industry that rebuilt its entire safety culture around the principle that hierarchy, in a cockpit or control tower, cannot be allowed to silence a concern. Crew Resource Management gave co-pilots not just permission but a structured obligation to speak up, regardless of seniority. Near-miss reporting removed the threat of punishment from honesty. Safety culture became something designed into the system, not dependent on the courage of individuals.

In manufacturing, parallel principles emerged. James Reason’s Swiss Cheese model gave organisations a language for understanding that failures are almost never caused by one person, but instead they happen when holes in multiple defensive layers happen to align. Toyota’s production system gave every worker on the line the ability to stop everything the moment something didn’t look right.

The message was clear and consistent: the system is designed to receive your concern. You don’t need to be brave to raise it. Speaking up is what we do here.

Healthcare has borrowed much of this thinking, and rightly so. Just Culture principles, incident reporting frameworks, the language of human factors, all have roots in what manufacturing and aviation learned the hard way over decades. And yet a significant gap remains. It sits not within the clinical team, but between the clinical team and the patient.

This is where healthcare faces a layer of complexity that manufacturing simply does not.

In manufacturing, the subject of a safety concern, whether it’s the process, the component or the output, has no psychological state. It isn’t frightened. It doesn’t defer to the expertise of the people responsible for it. It has no uncertainty about what ‘normal’ feels like, no anxiety that raising a concern might result in worse treatment, no cultural background or language barrier that makes speaking up feel impossible or unsafe.

A patient has all of these things. And they have them at the precise moment they are most vulnerable, most dependent on others and are least certain of their own ground. They are, in the truest sense, inside the system they are being asked to influence. That is a profoundly different position from a worker who can step back from a production line and raise a concern from a position of relative stability.

When a patient stays silent about something that concerns them, they are rarely choosing silence because they lack information or awareness. They are making a calculation (often unconsciously) based on the culture they are experiencing: the responsiveness of the people around them, the signals they have received about whether their voice is genuinely welcome, and the very human fear that being perceived as ‘difficult’ might affect the quality of their care.

In a system where patients feel they must be compliant to be safe, we have already failed at the most fundamental level.

Traditionally, healthcare has tried the route of patient education, but you cannot close this gap just by training patients to be more assertive or by producing better information leaflets about how to raise concerns. It is an organisational and leadership problem—and I believe one that requires the same system-level thinking that transformed safety culture in manufacturing.

It requires leaders who understand that psychological safety for patients is not a clinical add-on. It is a core organisational competency. Leaders who ask not just "did we give the patient an opportunity to speak?" but "have we genuinely designed a system in which speaking up is the path of least resistance—and in which our teams have the skills and the capacity to hear what patients say, and act on it?"

My extensive work on health and safety behaviour change in manufacturing and technical organisations has consistently shown that the leadership behaviours which create safety: active listening, psychological safety, the reward of raising concerns rather than resolving them quietly, are not industry-specific. They are human. What is industry-specific is the stakes when those behaviours are absent.

In manufacturing, a missed signal can cost a product. In healthcare, it can cost a life.

The framework for getting this right already exists. Manufacturing and aviation built it over decades of hard-won experience. The question for healthcare is not whether to adopt this system-level thinking, but how to adapt it for the unique human complexity, variability and vulnerability that patient care brings.

That work starts with leadership. It always does.

About the Author

Annette Cairns is a Leadership Development Facilitator who works in both healthcare and manufacturing. When working in Ramsay Health Care UK, she was asked by the Clinical Director to find a programme for Human Factors, and became fascinated by the subject, to the extent that she developed the course herself and rolled it out to hospitals within the group to all employees. She is a firm believer that everyone in a hospital has an input in patient care and safety. She now manages her own business, Green Shed Talent Development Ltd, offering programmes in Leadership, Safety in leadership and Building High Performance Teams.