Andrew Carson-Stevens
1*, Liam Donaldson
2, Aziz Sheikh
31 Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.
2 London School of Hygiene and Tropical Medicine, London, UK.
3 Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
Abstract
Who could disagree with the seemingly common-sense reasoning that: “We must learn from the things that go
wrong.”? Despite major investments to improve patient safety, relatively few evaluations demonstrate convincing
reductions in risk, harm, serious error or death. This disappointing trajectory of improvement from learning
from errors or Safety-I as it is sometimes known has led some researchers to argue that there is more to be
gained by learning from the majority of healthcare episodes: the things that go right. Based on this premise, socalled
Safety-II has emerged as a new paradigm. In this commentary, we consider the ongoing value of Safety-I
based approaches and explore whether now is the time to abandon learning from “the bad” and re-energise data
collection and analysis by focusing on “the good.”