What kinds of insights do Safety-I and Safety-II approaches provide? a critical reflection on the use of SHERPA and FRAM in healthcare

Over the past decade, the field of healthcare has seen a significant shift in its approach to patient safety. Traditionally, safety efforts focused on understanding past harm and preventing errors, primarily through the use of standardisation and the introduction of barriers and safeguards, such as standardised communication protocols (e.g., SBAR (Haig et al., 2006)), checklists (e.g., WHO surgical safety checklist (Haynes et al., 2009)) and technology with safety features (e.g., smart infusion pumps (Taxis and Franklin, 2011)). This type of thinking about patient safety in terms of past harm and errors is also referred to as Safety-I (Hollnagel, 2014), even though this terminology has been criticised as it does not reflect adequately the diversity in safety science thinking (Leveson, 2020). However, the evidence for whether interventions based on this (Safety-I) thinking lead to improvements in patient safety is mixed at best (Kellogg et al., 2017, Wears and Sutcliffe, 2019), and critics have argued that the additional “safety clutter” produced as a result of such interventions might be counterproductive (Rae et al., 2018, Halligan et al., 2023).