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The systems approach to medicine: controversy and misconceptions
  1. Sidney W A Dekker1,
  2. Nancy G Leveson2
  1. 1Safety Science Innovation Lab, Griffith University, HUM, Nathan Campus, Queensland, Australia
  2. 2Aeronautics and Astronautics and Engineering Systems Division, Massachusetts Institute of Technology, Aeronautics and Astronautics, Cambridge, Massachusetts, USA
  1. Correspondence to Professor Sidney W A Dekker, Safety Science Innovation Lab, Griffith University, HUM, N16 Macrossan Building, 170 Kessels Road, Nathan Campus, QLD 4111, Australia; s.dekker{at}


The ‘systems approach’ to patient safety in healthcare has recently led to questions about its ethics and practical utility. In this viewpoint, we clarify the systems approach by examining two popular misunderstandings of it: (1) the systematisation and standardisation of practice, which reduces actor autonomy; (2) an approach that seeks explanations for success and failure outside of individual people. We argue that both giving people a procedure to follow and blaming the system when things go wrong misconstrue the systems approach.

  • Quality improvement
  • Patient safety
  • Human error
  • Human factors
  • Complexity
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