The implementation of Safety Management Systems in healthcare: a systematic review and international comparison (March 2025)

Summary

In healthcare, errors could have serious consequences for patients and staff. High-risk industries, such as aviation, have improved safety by taking a systems approach, known as safety management systems. Safety management systems are generally considered to have four key components: leadership commitment and safety policy; safety risk management; safety assurance; and safety culture. Safety management systems need to be context-specific to be effective. Evidence on the use of safety management systems in health care is therefore needed to inform policy decisions.

A systematic review was undertaken to investigate the application of safety management systems to patient safety in terms of effectiveness, implementation and experience. The authors included evidence from Australia, Canada, Ireland, the Netherlands and New Zealand because their healthcare systems are similar to the United Kingdom’s. They included policy documents, research papers and accounts of patient and staff experiences.

Content

The study found that the Netherlands was the only country with a patient safety programme explicitly based on a safety management system approach. The programme was associated with improvement in some aspects of patient safety in hospitals but there was significant variation in its implementation and outcomes.

The main components of a safety management system were also identified to some extent in the patient safety approaches of the other four countries, along with evidence of influence from high-risk industries and ‘safety science’ more widely.

Across all five countries, there was a change in the patient safety discourse away from the narrow focus on reporting and learning from incidents. Without denying the importance of this element, the new approaches to patient safety adopted broader definitions of safety (e.g. including psychological and cultural safety) and harm (e.g. including harm resulting from social inequalities and structural oppression), and emphasised the importance of taking a systems perspective and involving everybody, especially patients and families, in the processes of assessing and creating safety, and learning from successful practice as well as failures. Although these new ideas were present in the policies of all countries, their translation into practice was not always clear, and robust evidence of their effectiveness was not available.

Although there is a considerable overlap between the Dutch PSP and the NHS patient safety strategy in terms of specific components, one important difference is the role of leadership within individual healthcare organisations. While the role of leadership is also acknowledged in the NHS patient safety strategy, the responsibilities of the top management and the lines of accountability in relation to patient safety within a healthcare organisation are not always clearly defined. The responsibilities of local patient safety specialists are most clear but they may not have the authority or capacity to ensure patient safety throughout the organisation.