Can the concept of Safety II be used to Improve diagnosis?

Gerrit Jager gerrit.jager at PLANET.NL
Sun Dec 9 13:00:22 UTC 2018

Dear members, 

I have a question.

Diagnostic error is the Œnew frontier on patient safety¹. In thinking about
patient safety there has been a shift from Safety I to safety II.  To
summarize Erik Hollnagel
ŒSafety has traditionally been defined as a condition where the number of
adverse outcomes was as low as possible (Safety-I). 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.¹

ŒFocusing on what goes right, rather than on what goes wrong, changes the
definition of safety from ¹avoiding that something goes wrong¹ to ¹ensuring
that everything goes right¹. 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.  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.¹
(White paper about Safety is attached)

I experience the same paradox in our society. It is about Improving
Diagnosis (safety II) but our conferences are about Diagnostic errors
(Safety I).
It¹s like a society that studies ³the secrets of a happy marriage² by
interviewing divorced couples.

The literature concerning Diagnosis and safety II is scarce.
Does anyone has ideas or literature about this topic and suggestions how we
can use this concept to improve diagnosis in medicine.


Gerrit Jager
Officer Patient Safety

Moderator: David Meyers, Board Member, Society to Improve Diagnosis in Medicine

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