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• Moving from Safety I to Safety II, but what about the media?
  Nick Woodier
  Published on: 13 May 2016

• Published on: 13 May 2016

  Moving from Safety I to Safety II, but what about the media?

  • Nick Woodier, Safety and Simulation Fellow

  To the Editor

  I have recently returned from the Association of Simulated Practice in Healthcare 2014 conference in Nottingham and whilst there was privileged to hear and meet Professor Erik Hollnagel. He presented eloquently on his work relating to “From Safety I to Safety II” [1] which provided an excellent opening for the conference’s theme of “Changing Behaviours.” His work sparked much debate and reflection, part...

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  To the Editor

  I have recently returned from the Association of Simulated Practice in Healthcare 2014 conference in Nottingham and whilst there was privileged to hear and meet Professor Erik Hollnagel. He presented eloquently on his work relating to “From Safety I to Safety II” [1] which provided an excellent opening for the conference’s theme of “Changing Behaviours.” His work sparked much debate and reflection, particularly by myself when presenting our simulation work related to the Duty of Candour. We opened with a discussion considering how the NHS was perceived by the general population of the UK. The conversation moved to the role of the media in driving the campaign for patient safety and openness.

  The media has embraced the reports of a small number of high profile failings in the NHS, with the now daily reporting of another “failure” or “cover-up”. It is therefore understandable why a large proportion of the population do not trust the NHS and feel there is a closed and dishonest culture [2]. The media focuses on the Safety I premise of failures [1]. This is driving the destruction of the NHS’s reputation and the wellbeing of staff and patients by focusing on the minority of outcomes which are negative. In November 2013, our local Trust was reported to be the second worst general hospital in England for avoidable deaths [3]. A review of the data and response from the Trust identified that the news report was misleading and the data inaccurate, causing unnecessary anxiety amongst patients and staff [4]. Such media reports place extra strain on the healthcare system with reputational damage and effects on morale which effect the ability of that organisation to sustain required operations.

  However, now 12 years later, the focus still remains on the serious errors, incidents and failures of the NHS. These events are still the minority of events, but the focus remains on what went wrong. As it is time for healthcare to focus on Safety II, should it not be the same for the media? By focussing on what goes right and the NHS's incredible ability to succeed under varying conditions, the media can celebrate the NHS and help to drive the next stage of safety improvement. It is time for the media to also move from Safety I to Safety II thinking.

  The discussion regarding media involvement in the NHS prompted me to consider this further and I read with great interest the 2002 paper published in BMJ Quality and Safety considering the role of the media in pushing patient safety forward as the priority [5]. There is no doubt that media involvement has benefitted the patient safety agenda, by acting as a “watchdog” to hold the medical profession accountable for improved safety and quality of care. This in turn has created a passionate group of healthcare professionals striving for excellence in care.

  12 years later, however, the focus still remains on the serious errors, incidents and failures of the NHS. These events are still the minority of events, but the focus remains on what went wrong. As it is time for healthcare to focus on Safety II, should it not be the same for the media? By focussing on what goes right and the NHS’s incredible ability to succeed under varying conditions [1], the media can celebrate the NHS and help to drive the next stage of safety improvement. It is time for the media to also move from Safety I to Safety II thinking.

  The difficulty will be in convincing the media of its role in the next stage of safety. It remains important for the NHS to be transparent, but a balance must be sought between the ongoing need for accurate reporting of serious problems and celebration of the NHS’s staff and its successes. In a recent well known report on health and healthcare service delivery [6], the UK ranked number one against ten other wealthy countries for overall healthcare (based on quality, access, efficiency and equity).

  Professor Hollnagel defined resilience as the ability of the healthcare system to adjust its functioning to sustain operations under both expected and unexpected conditions [1]. The media must understand the complexity of the NHS and be aware of the potential for their reporting to inadvertently remove those parts of the healthcare system that have contributed to its resilience.

  1) Hollnagel E. Safety I and Safety II: The Past and Future of Safety Management. Ashgate: Surrey, United Kingdom

  2) YouGov UK. One in two don’t trust the NHS. [Online] 2013. Available from: https://yougov.co.uk/news/2013/06/13/1-2-do-not-trust-nhs/ [Accessed 14th November 2014].

  3) Adams S. How 3,500 hospital patients lost their lives due to surgical errors or staff who were too busy to treat them... in just TWELVE months. The Mail on Sunday. [Online] November 09 2013. Available from: www.dailymail.co.uk [Accessed 14th November 2014].

  4) Nottingham University Hospitals NHS Trust. Response to Mail On Sunday coverage (avoidable deaths). [Online: media response] 2013. Available from: http://www.nuh.nhs.uk/media/1459425/response_to_mail_on_sunday_coverage.pdf [Accessed 14th November 2014].

  5) Millenson ML. Pushing the profession: how the news media turned patient safety into a priority. Qual Saf Health Care 2002; 11: 57–63.

  6) Davis K, Stremikis K, Schoen C, Squires D. Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally. The Commonwealth Fund. 2014.

  Conflict of Interest:

  None declared

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  Conflict of Interest:
  None declared.

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