Safety-I and Safety-II

Author: Erik Hollnagel
Publisher: CRC Press
ISBN: 1317059794
Category : Technology & Engineering
Languages : en
Pages : 158

Book Description
Safety has traditionally been defined as a condition where the number of adverse outcomes was as low as possible (Safety-I). From a Safety-I perspective, the purpose of safety management is to make sure that the number of accidents and incidents is kept as low as possible, or as low as is reasonably practicable. This means that safety management must start from the manifestations of the absence of safety and that - paradoxically - safety is measured by counting the number of cases where it fails rather than by the number of cases where it succeeds. This unavoidably leads to a reactive approach based on responding to what goes wrong or what is identified as a risk - as something that could go wrong. Focusing on what goes right, rather than on what goes wrong, changes the definition of safety from ’avoiding that something goes wrong’ to ’ensuring that everything goes right’. More precisely, Safety-II is the ability to succeed under varying conditions, so that the number of intended and acceptable outcomes is as high as possible. From a Safety-II perspective, the purpose of safety management is to ensure that as much as possible goes right, in the sense that everyday work achieves its objectives. This means that safety is managed by what it achieves (successes, things that go right), and that likewise it is measured by counting the number of cases where things go right. In order to do this, safety management cannot only be reactive, it must also be proactive. But it must be proactive with regard to how actions succeed, to everyday acceptable performance, rather than with regard to how they can fail, as traditional risk analysis does. This book analyses and explains the principles behind both approaches and uses this to consider the past and future of safety management practices. The analysis makes use of common examples and cases from domains such as aviation, nuclear power production, process management and health care. The final chapters explain the theoret

Safety-II in Practice

Author: Erik Hollnagel
Publisher: Taylor & Francis
ISBN: 135178076X
Category : Technology & Engineering
Languages : en
Pages : 130

Book Description
Safety-I is defined as the freedom from unacceptable harm. The purpose of traditional safety management is therefore to find ways to ensure this ‘freedom’. But as socio-technical systems steadily have become larger and less tractable, this has become harder to do. Resilience engineering pointed out from the very beginning that resilient performance - an organisation’s ability to function as required under expected and unexpected conditions alike – required more than the prevention of incidents and accidents. This developed into a new interpretation of safety (Safety-II) and consequently a new form of safety management. Safety-II changes safety management from protective safety and a focus on how things can go wrong, to productive safety and a focus on how things can and do go well. For Safety-II, the aim is not just the elimination of hazards and the prevention of failures and malfunctions but also how best to develop an organisation’s potentials for resilient performance – the way it responds, monitors, learns, and anticipates. That requires models and methods that go beyond the Safety-I toolbox. This book introduces a comprehensive approach for the management of Safety-II, called the Resilience Assessment Grid (RAG). It explains the principles of the RAG and how it can be used to develop the resilience potentials. The RAG provides four sets of diagnostic and formative questions that can be tailored to any organisation. The questions are based on the principles of resilience engineering and backed by practical experience from several domains. Safety-II in Practice is for both the safety professional and academic reader. For the professional, it presents a workable method (RAG) for the management of Safety-II, with a proven track record. For academic and student readers, the book is a concise and practical presentation of resilience engineering.

Resilient Health Care

Author: Professor Robert L Wears
Publisher: Ashgate Publishing, Ltd.
ISBN: 1472469194
Category : Medical
Languages : en
Pages : 297

Book Description
Properly performing health care systems require concepts and methods that match their complexity. Resilience engineering provides that capability. It focuses on a system’s overall ability to sustain required operations under both expected and unexpected conditions rather than on individual features or qualities. This book contains contributions from international experts in health care, organisational studies and patient safety, as well as resilience engineering. Whereas current safety approaches primarily aim to reduce the number of things that go wrong, Resilient Health Care aims to increase the number of things that go right.

Safety Differently

Author: Sidney Dekker
Publisher: CRC Press
ISBN: 1482242001
Category : Technology & Engineering
Languages : en
Pages : 304

Book Description
The second edition of a bestseller, Safety Differently: Human Factors for a New Era is a complete update of Ten Questions About Human Error: A New View of Human Factors and System Safety. Today, the unrelenting pace of technology change and growth of complexity calls for a different kind of safety thinking. Automation and new technologies have resu

Resilience Engineering

Author: Professor David D Woods
Publisher: Ashgate Publishing, Ltd.
ISBN: 1409463060
Category : Transportation
Languages : en
Pages : 511

Book Description
For Resilience Engineering, 'failure' is the result of the adaptations necessary to cope with the complexity of the real world, rather than a malfunction. Human performance must continually adjust to current conditions and, because resources and time are finite, such adjustments are always approximate. Featuring contributions from leading international figures in human factors and safety, Resilience Engineering provides thought-provoking insights into system safety as an aggregate of its various components - subsystems, software, organizations, human behaviours - and the way in which they interact.

Rethinking Patient Safety

Author: Suzette Woodward
Publisher: CRC Press
ISBN: 1351651064
Category : Medical
Languages : en
Pages : 166

Book Description
The vast majority of healthcare is provided safely and effectively. However, just like any high-risk industry, things can and do go wrong. There is a world of advice about how to keep people safe but this delivers little in terms of changed practice. Written by a leading expert in the field with over two decades of experience, Rethinking Patient Safety provides readers with a critical reflection upon what it might take to narrow the implementation gap between the evidence base about patient safety and actual practice. This book provides important examples for the many professionals who work in patient safety but are struggling to narrow the gap and make a difference in their current situation. It provides insights on practical actions that can be immediately implemented to improve the safety of patient care in healthcare and provides readers with a different way of thinking in terms of changing behavior and practices as well as processes and systems. Suzette Woodward shares lessons from the science of implementation, campaigning and social movement methods and offers the reader the story of a discovery. Her team has explored an approach which could profoundly affect the safety culture in healthcare; a methodology to help people talk to each other and their patients and to listen through facilitated safety conversations. This is their story.

Patient Safety and Quality Improvement in Healthcare

Author: Rahul K. Shah
Publisher: Springer Nature
ISBN: 3030558290
Category : Medical
Languages : en
Pages : 394

Book Description
This text uses a case-based approach to share knowledge and techniques on how to operationalize much of the theoretical underpinnings of hospital quality and safety. Written and edited by leaders in healthcare, education, and engineering, these 22 chapters provide insights as to where the field of improvement and safety science is with regards to the views and aspirations of healthcare advocates and patients. Each chapter also includes vignettes to further solidify the theoretical underpinnings and drive home learning. End of chapter commentary by the editors highlight important concepts and connections between various chapters in the text. Patient Safety and Quality Improvement in Healthcare: A Case-Based Approach presents a novel approach towards hospital safety and quality with the goal to help healthcare providers reach zero harm within their organizations.

Risk Science

Author: Terje Aven
Publisher: Routledge
ISBN: 1000435032
Category : Technology & Engineering
Languages : en
Pages : 427

Book Description
Risk science is becoming increasingly important as businesses, policymakers and public sector leaders are tasked with decision-making and investment using varying levels of knowledge and information. Risk Science: An Introduction explores the theory and practice of risk science, providing concepts and tools for understanding and acting under conditions of uncertainty. The chapters in this work cover the fundamental concepts, principles, approaches, methods and models for how to understand, assess, communicate, manage and govern risk. These topics are presented and examined in a way which details how they relate, for example, how to characterize and communicate risk with particular emphasis on reflecting uncertainties; how to distinguish risk perception and professional risk judgments; how to assess risk and guide decision-makers, especially for cases involving large uncertainties and value differences; and how to integrate risk assessment with resilience-based strategies. The text provides a variety of examples and case studies that relate to highly visible and relevant issues facing risk academics, practitioners and non-risk leaders who must make risk-related decisions. Presenting both the foundational and most recent advancements in the subject matter, this work particularly suits students of risk science courses at college and university level. The book also provides broader key reading for students and scholars in other domains, including business, engineering and public health.

To Err Is Human

Author: Institute of Medicine
Publisher: National Academies Press
ISBN: 0309068371
Category : Medical
Languages : en
Pages : 312

Book Description
Experts estimate that as many as 98,000 people die in any given year from medical errors that occur in hospitals. That's more than die from motor vehicle accidents, breast cancer, or AIDSâ€"three causes that receive far more public attention. Indeed, more people die annually from medication errors than from workplace injuries. Add the financial cost to the human tragedy, and medical error easily rises to the top ranks of urgent, widespread public problems. To Err Is Human breaks the silence that has surrounded medical errors and their consequenceâ€"but not by pointing fingers at caring health care professionals who make honest mistakes. After all, to err is human. Instead, this book sets forth a national agendaâ€"with state and local implicationsâ€"for reducing medical errors and improving patient safety through the design of a safer health system. This volume reveals the often startling statistics of medical error and the disparity between the incidence of error and public perception of it, given many patients' expectations that the medical profession always performs perfectly. A careful examination is made of how the surrounding forces of legislation, regulation, and market activity influence the quality of care provided by health care organizations and then looks at their handling of medical mistakes. Using a detailed case study, the book reviews the current understanding of why these mistakes happen. A key theme is that legitimate liability concerns discourage reporting of errorsâ€"which begs the question, "How can we learn from our mistakes?" Balancing regulatory versus market-based initiatives and public versus private efforts, the Institute of Medicine presents wide-ranging recommendations for improving patient safety, in the areas of leadership, improved data collection and analysis, and development of effective systems at the level of direct patient care. To Err Is Human asserts that the problem is not bad people in health careâ€"it is that good people are working in bad systems that need to be made safer. Comprehensive and straightforward, this book offers a clear prescription for raising the level of patient safety in American health care. It also explains how patients themselves can influence the quality of care that they receive once they check into the hospital. This book will be vitally important to federal, state, and local health policy makers and regulators, health professional licensing officials, hospital administrators, medical educators and students, health caregivers, health journalists, patient advocatesâ€"as well as patients themselves. First in a series of publications from the Quality of Health Care in America, a project initiated by the Institute of Medicine

Hazard Analysis Techniques for System Safety

Author: Clifton A. Ericson, II
Publisher: John Wiley & Sons
ISBN: 0471739413
Category : Technology & Engineering
Languages : en
Pages : 521

Book Description
A practical guide to identifying hazards using common hazard analysis techniques Many different hazard analysis techniques have been developed over the past forty years. However, there is only a handful of techniques that safety analysts actually apply in their daily work. Written by a former president of the System Safety Society and winner of the Boeing Achievement and Apollo Awards for his safety analysis work, Hazard Analysis Techniques for System Safety explains, in detail, how to perform the most commonly used hazard analysis techniques employed by the system safety engineering discipline. Focusing on the twenty-two most commonly used hazard analysis methodologies in the system safety discipline, author Clifton Ericson outlines the three components that comprise a hazard and describes how to use these components to recognize a hazard during analysis. He then examines each technique in sufficient detail and with numerous illustrations and examples, to enable the reader to easily understand and perform the analysis. Techniques covered include: * Preliminary Hazard List (PHL) Analysis * Preliminary Hazard Analysis (PHA) * Subsystem Hazard Analysis (SSHA) * System Hazard Analysis (SHA) * Operating and Support Hazard Analysis (O&SHA) * Health Hazard Assessment (HHA) * Safety Requirements/Criteria Analysis (SRCA) * Fault Tree Analysis (FTA) * Event Tree Analysis (ETA) * Failure Mode and Effects Analysis (FMEA) * Fault Hazard Analysis * Functional Hazard Analysis * Sneak Circuit Analysis (SCA) * Petri Net Analysis (PNA) * Markov Analysis (MA) * Barrier Analysis (BA) * Bent Pin Analysis (BPA) * HAZOP Analysis * Cause Consequence Analysis (CCA) * Common Cause Failure Analysis (CCFA) * MORT Analysis * Software Safety Assessment (SWSA) Written to be accessible to readers with a minimal amount of technical background, Hazard Analysis Techniques for System Safety gathers, for the first time in one source, the techniques that safety analysts actually apply in daily practice. Both new and seasoned analysts will find this book an invaluable resource for designing and constructing safe systems-- in short, for saving lives.