ABSTRACT
Traditionally, patient safety has been approached from one of three paradigms: focus on (1) reducing healthcareprofessional(HCP)errors,(2)reducingpatientinjuries,and(3)improvingtheuseofevidence-basedmedicine.Ÿefirstparadigmproposedthat,toachievepatientsafety,errorscommitted byHCPsmustbeprevented,eliminated,orreduced.ŸisparadigmisexemplifiedbytheInstituteof Medicine(IOM)reportthatproposedfocusingonerrorreductionthroughthedesignofsafersystems (InstituteofMedicine2000).Afollow-upreportbytheIOMcontinuedsupportingtheerrorprevention paradigmbyexplaining,“anewdeliverysystemmustbebuilttoachievesubstantialimprovementsin patientsafety-asystemthatiscapableofpreventingerrorsfromoccurringinthefirstplace,whileatthe sametimeincorporatinglessonslearnedfromanyerrorsthatdooccur”(InstituteofMedicine2004). Inanarticlepresentingthesecondparadigm,Laydeetal.(2002)arguedthatbecauseerrorandharm arenotalwayslinked,patientsafetyeffortsshouldfocusonreducingpatientinjuries.Errorsthatdonot leadtoharm,o·encallednearmissesornearhits,mayoccurwhenluckisinvolved,whentheerroris notclinicallysignificantenoughtocauseharm,orwhentheerroriscaughtbeforeharmcanbedone. Ÿeauthorsarguethatsincesomeerrorsdonotresultinpatientharm,notallerrorsareworthtryingto eliminate.Instead,theyproposethatindividualsinhealthcaredeliverysystemsanalyzepatientharm, determinewhatfactors,includingerrors,contributetoharm,andthenredesignthesystemofcareto eliminateallfactorsthatcontributetoharm,includingfactorsthatcauseerrors.Ÿethirdparadigm proposedbyBrennanetal.(2005)focusesonimplementingevidence-basedpracticesforqualitypatient
care-if clinicians follow evidence-based practices, then the patients will receive more appropriate, and, therefore,higherqualitycare.Higherqualitycare,theyargue,willalsobesafercare.Ÿeypointoutthat safetysciencecancontributetoabetterunderstandingofhowtodesignforbothsafeandeffectivecare. Underlyingallthreeparadigmsisthebeliefthat,toachievesafety,changesareneededinthedesignof thesystemwherepatientsreceivecare.Ÿefirsttwo,however,arereactivebecausetheyrequirewaiting for errors or injuries to occur.
