Safety Is a Moving Target
Safety is, in a number of respects, a constantly moving target. As standards improve and concern for safety grows within a system, a larger number of events will come to be considered as safety issues. In a very real sense innovation and improving standards create new forms of harm in that there are new ways the healthcare system can fail patients.
In the 1950s many complications of healthcare were recognised, at least by some, but largely viewed as the inevitable consequences of medical intervention (Sharpe and Faden 1998). Gradually, certain types of incidents have come to seem both unacceptable and potentially preventable. The clearest example in recent times is healthcare-associated infection, which is no longer viewed as an unfortunate side effect of healthcare. With increased understanding of underlying processes, mechanisms of transmission and methods of prevention, coupled with major public and regulatory pressure, such infections are becoming unacceptable to both patients and professionals (Vincent and Amalberti 2015).
In the last 10 years, as more types of harm have come to be regarded as preventable, the perimeter of patient safety has expanded. A larger number of harmful events are now regarded as 'unacceptable'. In addition to infections we could now include, in the British NHS, pressure ulcers, falls, venous thromboembolism and catheter associated urinary tract infections. In the United Kingdom the Francis Report into Mid Staffordshire Hospitals NHS Trust highlighted additional risks to patients, such as malnutrition, dehydration and delirium all of which are now being viewed as safety issues. We should also consider adverse drug reactions in the community that cause admission to hospital, polypharmacy and general harm from overtreatment. All these, in the past, might have been regretted but are now receiving greater attention through being viewed under the safety umbrella.
The perimeter of safety is therefore expanding but this does not mean that healthcare is becoming less safe. A long-standing concern with safety in such specialties as anaesthesia and obstetrics is actually a marker of the high standards these specialties have achieved. Safety is an aspiration to better care and labelling an issue as a safety issue is a strongly motivational, sometimes emotional, plea that such outcomes cannot and should not be tolerated (Vincent and Amalberti 2015).
