Project title:

A patient safety framework to facilitate embedding higher level safety culture tools into the healthcare economy.

Type of research:

Qualitative using mixed methods for data gathering and (primarily) system modelling for data analysis, theory development and presentation of findings.

Background & Strength of Evidence:

Despite extensive academic research into patient safety, the causes and consequences of incidents and how patient safety can be improved, the level of unintended harm remains stubbornly high. In particular the inability of healthcare practitioners to benefit from the experience of hazardous, safety critical industries, such as civil aviation, nuclear power and oil & gas, where significant safety improvements have been made, has been commented upon frequently. It has long been recognised that errors are made and safety compromised because the systems that people work within are poorly designed; under these conditions, errors are a ‘normal’ component of the activity in that they express an attempt to resolve the mismatch between the features of the working conditions (as embedded in the organisational goal structure, resource allocation, training programs) and the task requirements they are supposed to meet. Hence to improve safety you need to design better tools and/or the work environment. Design theory informs us that the first stage of effective design is to explore and understand the problem to be solved before trying to design the solution. System modelling provides an array of techniques for helping those involved in designing changes to complex systems, such as healthcare, to better understand the condition they are seeking to improve before embarking on making changes.

Research questions / aims:

The aims of this research are to develop a causal functional systemic model (Ex. System dynamics modelling, Brown 2002) of the factors that influence patient safety outcomes The model, supplemented by a comparison against other models for safety critical industries, is expected to be used to position the other projects in this research theme in their overall context and provide a conceptual framework for improvement projects and the development of patient safety guidance in future.

Proposed methods

The first version of a patient safety systems model will be created based on a literature review and tested using of system dynamics and control theory models. Interviews will take place with members of a panel of patient safety experts, and a review of incident/accident reports will be conducted with the aid of domain experts. This current state model will then be refined iteratively. The members of the expert panel will be surveyed for their comments on each iteration of the model until it converges to a workable model. It is likely that extra data will need to be gathered throughout this process using whatever the most appropriate methods might be e.g. surveys or interviews for primary data. In parallel to developing the patient safety systems model other models for safety critical industries will be reviewed and used to articulate a rationale for our proposed safety management framework using the same methods and involving an expert panel with knowledge of safety in those industries. In Phase II of the research the two models – 1) patient safety and 2) safety critical industries – will be compared and contrasted. This comparison is expected to identify differences in: i) the relative importance of different system elements and ii) the strength of the relationships between them.

Expected Output of Research / Impact and added value:

The main outputs from this research are:

  • A qualitative comparison between our systemic safety management model and others developed for safety critical industries.
  • A high-level systems model showing the relationships between patient safety outcomes types and the various factors in the healthcare system influencing these outcomes.
  • A mapping between the models, opportunities and the other Patient Safety research project (WPs 3-6).
  • Project report detailing the suggested framework to implementing a SMS in the Eastern region


For further information on this project, contact Dr Terry Dickerson, Assistant Director – Healthcare Design, Cambridge Engineering Design Centre, University of Cambridge



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