Future Directions for Research and Practice

This short book and these proposals are a first step. We believe that there are immediate implications but recognise that if the ideas have merit then they need to be debated, developed further and tested in practice by a community of people. The table in Chap. 11 provides, as we expressed it, an incomplete taxonomy. We know that much more work is need to map the full set of strategies and interventions, assess the value of the overall framework, the nature and purpose of the various interventions and their effectiveness in practice. Our experience so far from the small group of people who generously found time to read an earlier draft is that they recognised the need for a broader view of safety, for a breadth of strategic approach and particularly to the need to customise approaches to safety to different settings and along the patient journey.

The next step is broadly ethnographic. We need to observe, identify and collate safety relevant strategies and interventions at all levels of healthcare organisations and the wider system. Ideally these could be compared and matched with approaches taken in other industries. From there we could develop a more robust taxonomy of approaches and begin to assess which might be applicable in different contexts. A considerable amount of research and empirical work is needed to map the full set of strategies and interventions currently in use, who they are used by and in what context. From this point we could envisage empirical testing of different approaches and combinations of interventions, similar to those already developed for best practice and system improvement but employing a wider repertoire of approaches and, most important of all, being tested at every level of the system.

Many ideas and approaches to safety have been advanced; the very term safety has been contested and defined in numerous ways. We have a plethora of concepts and organisational ideals to guide us on the safety journey. Many of these ideas however have remained as ideas and not found a concrete expression or application. Our approach in contrast, abstract as it may seem to some, is resolutely practical in intention. The safety strategies and approaches we describe are all in use but have not been drawn together in a comprehensive architecture which attempts to embrace all healthcare settings. We have found in previous work that a unifying framework can be valuable to those managing safety at all levels of the healthcare system. We hope that our proposals and the attempt to develop an architecture of safety interventions will be useful now and productive for the future.