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Risk management has a number of accident causation models that have been used for a number of years. Dr Nancy Leveson has developed a new model of accidents using a systems approach. The new model is called Systems Theoretic Accident Modeling and Processes (STAMP). It incorporates three basic components: constraints, hierarchical levels of control, and process loops. In this model, accidents are examined in terms of why the controls that were in place did not prevent or detect the hazard(s) and why these controls were not adequate to enforcing the system safety constraints. Altabbakh et al. present STAMP accident analysis and its usefulness in evaluating system safety is compared to more traditional risk models. STAMP is applied to a case study in the oil and gas industry to demonstrate both practicality and validity of the model. The model successfully identified both direct and indirect violations against existing safety constraints that resulted in the accident at each level of the organisation.

We need less research, better research, and research done for the right reasons says D G Altman in this BMJ editorial.

Guest blogger for PLOS Blogs 'Speaking of Medicine', Trish Greenhalgh, suggests its time for less research and more thinking.

Traditionally, clinicians present complications at surgical morbidity and mortality (M&M) conferences, and the AHRQ Patient Safety Indicators (PSIs) use inpatient administrative data to identify certain adverse outcomes. Although both methods are used to identify adverse events and inform quality improvement efforts, these two methods might not overlap. This is a retrospective observational study from Anderson et al. of all hospitalisations at a single academic department of surgery (including subspecialties) in 2016 involving a PSI-defined event identified by surgery faculty and residents for review by departmental M&M conference or administrative data. The authors analysed the degree to which these two processes captured PSI-defined events and reasons for exclusion by each process. The study found that surgical M&M and the PSIs are complementary approaches to identifying complications. Both case-finding processes should be used to inform quality improvement efforts.

Preventable adverse events are an ongoing challenge in healthcare. International studies demonstrate that 3%–17% of admissions are associated with an adverse event (defined as an injury caused by healthcare management resulting in prolonged hospitalisation, disability on discharge or death). Approximately half of the adverse events are preventable. Little is known about adverse events in the Irish healthcare system.Therefore, recommendations on improving patient safety at a national level are being made on limited information. The aim of the Irish National Adverse Events Study (INAES) from Rafter et al. was to quantify the frequency and nature of adverse events in acute hospitals in the Republic of Ireland for the first time using an internationally recognised retrospective patient chart review methodology.

This study from Cho et al. examined the association of nurse staffing and education with the length of stay of surgical patients in acute care hospitals in South Korea. They found that nurse staffing and nurses’ education levels were significantly associated with the length of stay of surgical patients in South Korean hospitals. The findings from this study suggest that the South Korea healthcare system should develop appropriate strategies to improve the nurse staffing and education levels to ensure high-quality patient care in hospitals.