High-risk industries – such as aviation, oil and gas, and mining – are distinguished by their use of proactive methods for detecting hazards and managing risks. Many have achieved exemplary safety performance. In contrast, health care has continued to have a high level of harm events. Hence Safer Clinical Systems – a determined effort to improve the functioning of clinical systems through a hybrid of tools, techniques and principles adapted from those used by hazardous industries and quality improvement, and customised for health care. The Safer Clinical Systems approach aims to improve patient safety not by imposing predefined solutions on organisations, but by developing their own capacity to detect and assess system-level weaknesses (‘hazards’ and the associated risks) and introduce interventions to address them (‘risk controls’). It is distinguished by its proactive character, in contrast to approaches that rely mainly on analysis of incidents that have already occurred. Its development was led by a support team at the University of Warwick. The approach was tested and developed over two phases of a Health Foundation programme. Safer Clinical Systems phase 2, which ran from 2011 to 2014, used learning from a first phase of the programme. This second phase sought to test a prototype of the approach – not one that was fully or finally specified at the outset. The programme involved eight highly motivated teams from hospital sites in the NHS, recruited partly on the basis of previous experience of improvement work. The site project teams typically comprised a clinical lead and a project manager as well as individuals with a clinical or managerial background.
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