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How safe is the safety paradigm?
  1. O A Arah1,2,
  2. N S Klazinga2
  1. 1Netherlands Institute for Health Sciences, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
  2. 2Department of Social Medicine, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to:
 Dr O A Arah
 Department of Social Medicine, Division of Clinical Methods and Public Health, Academic Medical Center, University of Amsterdam, P O Box 22700, Amsterdam 1100 DE, The Netherlands;


This paper reviews safety initiatives in the health systems of the UK, Canada, Australia, and the US. Initiatives to tackle safety shortcomings involve public-private collaborations. Patient safety agencies (to institute learning, action and safety culture), adverse event reporting and, to a lesser extent, safety related performance indicators are currently used to design safer health systems. Their benefits are mixed, but there is little debate as to their possible side effects. Foreseeable adverse effects of multiple safety organisations stem from them being too many, too vague, too narrowly focused, threatened by the medical practice environment, and too optimistic. Safety related performance indicators are most developed in the US but suffer from inadequacies of administrative data, underreporting, variable indicator definitions, “extended” use, and low sensitivity of the diagnosis coding system, and arguable preventability of the prescribed conditions. A critical appraisal of the implications of these deficiencies is important to assure the safety of current health system safety initiatives and to establish evidence based safety. It is necessary to embed health system safety (as well as patient safety) in the societal culture, structures, and policies which promote effective, user centred, high performance care while allowing for healthy innovation.

  • health system safety
  • patient safety
  • adverse event reporting
  • safety indicators

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  • Funding: Ministry of Health, Welfare and Sport, The Hague, the Netherlands.