Definition of safety | ‘Safety’ entails that as many things as possible go right | Providers will have to report on improvements in the number of things that go right, and on underlying argument on what is ‘right’ | Providers and regulators need to agree on what is ‘right’ and how this relates to ‘Work As Done’ | Regulators’ use of the Short Observational Framework for Inspection as method for inspectors to assess the quality of care for people with dementia |
Safety management principle | Proactive; continuously trying to anticipate developments and events | Providers should show they have structures and processes in place with which to respond effectively to unforeseen situations | Regulators will use conversations with boards and inspections on site to assess how consistent the boards stories are with experiences on shop floor | Regulation of care for the disabled through format-free Quality Reports that providers publish |
The human factor in safety management | Humans are seen as a resource necessary for system flexibility and resilience. Humans provide flexible solutions to many potential problems | Focus on (interdisciplinary) teamwork, accessibility of higher management for healthcare professionals’ experiences and ‘Joy in work’ | Regulators should engage in open conversation with healthcare providers on how they empower their employees to fulfil this role adequately | Requirement for ‘peer support’ after serious adverse events |
Accident investigation | The purpose of an investigation is to understand how things usually go right as a basis for explaining how things occasionally go wrong | External accountability will also require healthcare providers to look into what went wrong | Regulators could combine Safety-I and Safety-II by judging whether the healthcare provider has looked into why the event occurred and into what could be done to strengthen resilience | Healthcare providers using ‘functional resonance analysis method’ to analyse adverse events |
Risk assessment | Focused on understanding the conditions where performance variability can become difficult or impossible to monitor and control | Providers should report on how the organisation monitors and controls performance variability | Regulators can stimulate or mandate systems that monitor performance variability | Regulators assessing whether providers use ‘Quality Registries’ |