From a Reactive Past to a Proactive Future
The evolution of safety management from Safety-1 to Safety-2 reflects a fundamental shift in how organizations, particularly in the complex and demanding healthcare sector, approach risk and success. For decades, safety was primarily understood through the lens of Safety-1, a model that focused on preventing negative outcomes by investigating and fixing failures after they occurred. However, as systems became more intricate and interdependent, it became clear that simply reacting to incidents was no longer sufficient. This led to the emergence of Safety-2, a paradigm that seeks to understand why things go right most of the time and how the system's inherent resilience contributes to success. By examining what works, Safety-2 complements the traditional reactive approach, providing a richer, more comprehensive understanding of safety as a dynamic state rather than a static outcome.
The Foundational Principles of Safety-1
Safety-1 operates on a clear, straightforward premise: safety is the absence of harm. This model is characterized by several key principles:
- Reactive Management: The primary driver for improvement is an adverse event. When an incident or near-miss occurs, an investigation is launched to find the cause.
- Root-Cause Analysis: Tools like root-cause analysis are used to identify the chain of events leading to a failure. The goal is to pinpoint the exact reason for the failure and prevent its recurrence.
- Compliance and Procedures: Safety is often equated with strict adherence to rules, regulations, and standardized procedures. The system assumes that if everyone follows the rules, accidents will not happen. Human error is often seen as a problem to be controlled or eliminated through more rigid processes.
- Lagging Indicators: Performance is measured using lagging indicators, such as injury rates and incident reports. These metrics only provide information after something has already gone wrong.
The Shift to Safety-2: A New Perspective on Performance
Safety-2, pioneered by resilient engineering expert Erik Hollnagel, flips the script by asking a different question: "Why do things go right?" This proactive approach recognizes that most operations succeed despite daily variability and complexity. Key tenets of Safety-2 include:
- Proactive Resilience: Instead of focusing on failure, Safety-2 emphasizes understanding and building the system's capacity to adapt and succeed under varying conditions.
- Learning from Success: A central tenet is the study of routine, successful operations to understand the adaptations and behaviors that enable success. This moves beyond just learning from adverse events to learning from positive outcomes.
- Value of Human Adaptation: Unlike Safety-1, which often views human variability as a source of error, Safety-2 sees human adaptability as a critical asset. Frontline staff often develop ingenious workarounds and strategies that make the system function effectively, and this expertise is highly valued.
- Leading Indicators: Safety-2 focuses on leading indicators that can predict and improve safety before an incident occurs. This involves monitoring successful adaptations and understanding the conditions that allow for positive outcomes.
Complementary, Not Conflicting
It is crucial to understand that Safety-1 and Safety-2 are not competing philosophies designed to replace one another. Instead, they are complementary perspectives that, when used together, provide a more robust safety management system. Safety-1 remains important for investigating adverse events and maintaining baseline standards of compliance. Safety-2 builds on this foundation by providing a more holistic and forward-looking approach that addresses the inherent complexity of modern work environments. The best organizations leverage the strengths of both, reacting effectively to failures while also proactively building resilience based on everyday successes.
Comparing the Safety Philosophies
| Feature | Safety-1 (Reactive) | Safety-2 (Proactive/Resilience) |
|---|---|---|
| Focus | Minimizing what goes wrong (failure). | Maximizing what goes right (success). |
| Goal | Preventing incidents and errors. | Building resilience and adaptability. |
| Human Role | A source of error; a liability. | A source of solutions; an asset. |
| Investigation | Responds to adverse events; root-cause analysis. | Studies both successes and failures; appreciative inquiry. |
| Metrics | Lagging indicators (e.g., incident rates). | Leading indicators (e.g., successful adaptations). |
| Method | Focuses on standardized rules and compliance. | Embraces variability and contextual adaptation. |
| System View | Assumes the system works because it's well-designed. | Acknowledges complexity and dynamic conditions. |
Practical Examples in General Health
In a healthcare setting, the differences between these two safety approaches are particularly illuminating.
- Medication Error (Safety-1): After a nurse administers the wrong medication, a Safety-1 investigation would focus on what went wrong. Did the nurse follow the correct protocol? Was the drug clearly labeled? The response would likely involve retraining the nurse and potentially updating the hospital's medication administration policy to prevent a recurrence. The focus is on controlling the human element through rigid rules.
- Complex Patient Care (Safety-2): A Safety-2 approach would complement the above by examining successful patient handovers and treatments. How do teams consistently manage complex cases successfully? What informal adaptations and communication strategies do staff use in high-pressure situations? The insights from these successes could then be used to refine training and build more resilient protocols, recognizing and empowering the expertise of frontline staff.
Building a Resilient Healthcare System with Both Frameworks
Integrating Safety-1 and Safety-2 requires a cultural shift from a mindset of blame to one of learning and empowerment. Organizations can begin by encouraging staff to share both their failures and their successes without fear of retribution. Creating psychological safety is essential for this process to succeed. Safety leaders can also expand their investigation processes to include what went well, not just what went wrong, to uncover valuable insights into adaptive capacity. The ultimate goal is to create a more complete picture of system performance, one that understands both the sources of failure and the sources of success.
Learning from both negative and positive events creates a more complete picture of an organization's safety maturity and operational effectiveness. By understanding not just how to prevent incidents but also how to facilitate success, healthcare institutions can build more robust, resilient, and ultimately safer systems for patients and staff alike. For a deeper understanding of patient safety, consult authoritative resources such as the Agency for Healthcare Research and Quality (AHRQ) PSNet.
The Path Forward
The move towards incorporating Safety-2 principles represents a maturation of safety science. It acknowledges that in a world of increasing complexity, a purely reactive, rule-based approach has its limits. By embracing human variability as a source of strength and learning from successful performance, organizations can proactively build safer, more resilient systems. This combined perspective, which uses Safety-1 to understand failure and Safety-2 to build on success, offers a powerful and more sustainable way forward for ensuring safety across all industries, including the critical field of general health.
Conclusion: A More Complete View of Safety
In summary, the distinction between Safety-1 and Safety-2 is not about choosing one path over another, but rather about adopting a dual-lens approach to safety management. Safety-1 provides the necessary foundation for responding to adverse events and ensuring compliance, while Safety-2 offers a progressive framework for cultivating resilience by learning from success. By integrating both perspectives, organizations in the general health sector and beyond can move beyond simply preventing harm to actively fostering a robust and adaptive system that is inherently safer. This comprehensive strategy recognizes that a healthy system is one that learns from all its experiences—the good, the bad, and the routine—to continuously improve and protect its people.
