Implementation of safety management systems (SMS) in healthcare: a systematic review and international comparison (12 May 2026)

Summary

Many industries where safety is a priority (eg, aviation) use safety management systems (SMSs), but evidence on their use in healthcare is needed to determine whether they could support patient safety improvement. This study published in BMJ Open investigated the application of national-level SMSs to patient safety in terms of effectiveness, implementation and experience.

Using a systematic review case study approach, the authors identified patient safety organisations from five high-income countries that have publicly funded healthcare systems with universal coverage: Australia, Canada, Ireland, New Zealand and the Netherlands.

They found that only the Netherlands implemented a patient safety programme explicitly based on an SMS approach. Some aspects of patient safety in hospitals improved as a result, but there was significant variation in both the implementation of the programme and attributed outcomes. In the other four countries, the main components of an SMS were identified to some extent, along with evidence that their patient safety approaches had been influenced by concepts from high-risk industries and ‘safety science’ more widely.

The authors concluded that emerging ideas from high-risk industries (beyond SMSs) and broader safety science have influenced all countries, reflecting increasing awareness of the need for initiatives to be context-specific to be successful. However, their implementation and impact need further evaluation.