Safety paradoxes and safety culture.

James Reason

Commentary

Safety paradoxes and safety culture.

April 9, 2003

Reason J. Inj Control Safety Promot. 2003;7(1):3-14.

View more articles from the same authors.

Achieving a culture of safety is paramount in any high-risk industry, such as healthcare. This article discusses four safety paradoxes and how high reliability organizations (HROs) can overcome these paradoxes to foster a culture of safety.

Available at

Related Resources From the Same Author(s)

Probabilistic risk assessment of accidental ABO-incompatible thoracic organ transplantation before and after 2003.

February 6, 2008

American College of Endocrinology and American Association of Clinical Endocrinologists position statement on patient safety and medical system errors in diabetes and endocrinology.

December 7, 2005

Accident analysis of large-scale technological disasters applied to an anaesthetic complication.

March 6, 2005

Human error: models and management.

March 27, 2005

Human factor in cardiac surgery: errors and near misses in a high technology medical domain.

March 27, 2005

Beyond the organisational accident: the need for "error wisdom" on the frontline.

March 6, 2005

Enabling a learning healthcare system with automated computer protocols that produce replicable and personalized clinician actions.

August 4, 2021

ACR guidance document on MR safe practices: 2013.

March 21, 2013

The effects of three consecutive 12-hour shifts on cognition, sleepiness, and domains of nursing performance in day and night shift nurses: a quasi-experimental study.

October 20, 2021

Optimizing Pediatric Patient Safety in the Emergency Care Setting.

October 19, 2022

Outbreak investigation of COVID-19 among residents and staff of an independent and assisted living community for older adults in Seattle, Washington.

June 10, 2020

Using social and behavioural science to support COVID-19 pandemic response.

June 3, 2020

Evaluating implementation of a rapid response team: considering alternative outcome measures.

May 7, 2014

Incorrect surgical procedures within and outside of the operating room.

November 25, 2009

Incorrect surgical procedures within and outside of the operating room: a follow-up report.

July 27, 2011

Vital signs: improving antibiotic use among hospitalized patients.

March 26, 2014

What is preventable harm in healthcare? A systematic review of definitions.

August 8, 2012

"To err is human" but disclosure must be taught: a simulation-based assessment study.

February 28, 2018

Medical team training improves team performance: AOA critical issues.

October 18, 2017

Implementation of an electronic system for medication reconciliation.

February 28, 2007

Making polypharmacy safer for children with medical complexity.

April 5, 2023

Crowding in the Emergency Department: Challenges for the Care of Children.

March 15, 2023

Evaluation of effectiveness and safety of pharmacist independent prescribers in care homes: cluster randomised controlled trial.

March 1, 2023

Using proactive risk assessment (HFMEA) to improve patient safety and quality associated with intraocular lens selection and implantation in cataract surgery.

September 18, 2019

More than an apple a day: factors associated with avoidance of doctor visits among transgender, gender nonconforming, and nonbinary people in the USA.

September 23, 2020

A model for improving health care quality for transgender and gender nonconforming patients.

January 23, 2020

Hospital ward adaptation during the COVID-19 pandemic: a national survey of academic medical centers.

September 23, 2020

Improving patient handoffs and transitions through adaptation and implementation of I-PASS across multiple handoff settings.

September 16, 2020

Why do hospital prescribers continue antibiotics when it is safe to stop? Results of a choice experiment survey.

September 2, 2020

What has been the impact of Covid-19 on safety culture? A case study from a large metropolitan healthcare trust.

September 2, 2020

A systematic review of trauma crew resource management training: what can the United States and the United Kingdom learn from each other?

September 2, 2020

Effect of delays in the 2-week-wait cancer referral pathway during the COVID-19 pandemic on cancer survival in the UK: a modelling study.

August 19, 2020

Clinical reasoning in the wild: premature closure during the COVID-19 pandemic.

August 19, 2020

A randomized trial of a multifactorial strategy to prevent serious fall injuries.

July 29, 2020

Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: a multinational cross-sectional study.

May 5, 2021

Diagnostic errors in pediatric critical care: a systematic review.

April 28, 2021

We asked the experts: the WHO Surgical Safety Checklist and the COVID-19 pandemic: recommendations for content and implementation adaptations.

March 17, 2021

Systems approach to health service design, delivery and improvement: a systematic review and meta-analysis.

February 3, 2021

System issues leading to "found-on-floor" incidents: a multi-incident analysis.

January 27, 2021

Identifying trigger concepts to screen emergency department visits for diagnostic errors.

December 16, 2020

Errors in adult trauma resuscitation: a systematic review.

June 30, 2021

Filling a gap in safety metrics: development of a patient-centred framework to identify and categorise patient-reported breakdowns related to the diagnostic process in ambulatory care.

October 27, 2021

Impact of clinical decision support therapeutic interchanges on hospital discharge medication omissions and duplications.

October 20, 2021

Analysis of consistency in emergency department physician variation in propensity for admission across patient sociodemographic groups.

October 13, 2021

Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries: a nonrandomized controlled trial.

December 2, 2020

Safe use of the EHR by medical scribes: a qualitative study.

November 18, 2020

Twelve-month review of infusion pump near-miss medication and dose selection errors and user-initiated "good save" corrections: retrospective study.

November 4, 2020

National drug shortages worsen during COVID-19 crisis: proposal for a comprehensive model to monitor and address critical drug shortages.

November 4, 2020

Medication errors in anesthesiology: is it time to train by example? Vignettes can assess error awareness, assessment of harm, disclosure, and reporting practices.

October 28, 2020

Impact of full personal protective equipment on alertness of healthcare workers: a prospective study.

February 2, 2022

Using participatory design to engage physicians in the development of a provider-level performance dashboard and feedback system.

February 2, 2022

The MedSafer study-electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial.

February 2, 2022

Preventing and mitigating radiology system failures: a guide to disaster planning.

February 2, 2022

What counts as a voiceable concern in decisions about speaking out in hospitals: a qualitative study.

January 19, 2022

Racial and ethnic differences in emergency department pain management of children with fractures.

April 22, 2020

Validation of the second victim experience and support tool-revised in the neonatal intensive care unit.

January 12, 2022

Evaluation of clinical practice guidelines on fall prevention and management for older adults: a systematic review.

January 12, 2022

The influence of race and gender on pain management: a systematic literature review.

December 15, 2015

Malpractice cases in breast surgery: an assessment of litigation involving surgeons.

December 1, 2021

Racial disparities in pain management of children with appendicitis in emergency departments.

September 15, 2015

Provider bias in prescribing opioid analgesics: a study of electronic medical records at a hospital emergency department.

September 8, 2021

A system-wide hospital child maltreatment patient safety program.

September 8, 2021

Improving diagnostic performance through feedback: the Diagnosis Learning Cycle.

September 1, 2021

System factors affecting patient safety in the OR: an analysis of safety threats and resiliency.

August 25, 2021

Patient safety and quality improvement: ethical principles for a regulatory approach to bias in healthcare machine learning.

July 22, 2020

Medication discrepancy rates and sources upon nursing home intake: a prospective study.

April 6, 2022

Patient Safety Innovations

Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial.

April 7, 2022

Systems engineering analysis of diagnostic referral closed-loop processes.

March 9, 2022

Non-technical skills in surgery during the COVID-19 pandemic: an observational study.

March 9, 2022

Evaluation of communication and safety behaviors during hospital-wide code response simulation.

March 2, 2022

Eliminating explicit and implicit biases in health care: evidence and research needs.

February 23, 2022

Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023.

February 7, 2024

Psychological safety and hierarchy in operating room debriefing: reflexive thematic analysis.

January 31, 2024

Low rate of completion of recommended tests and referrals in an academic primary care practice with resident trainees.

January 31, 2024

Do patients who read visit notes on the patient portal have a higher rate of "loop closure" on diagnostic tests and referrals in primary care? A retrospective cohort study.

January 17, 2024

Nurses' perception of medication administration errors and factors associated with their reporting in the neonatal intensive care unit.

January 17, 2024

Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023.

December 13, 2023

Uncovering the risks of anticancer therapy through incident report analysis using a newly developed medical oncology incident taxonomy.

December 13, 2023

Transforming team performance through reimplementation of the surgical safety checklist.

December 6, 2023

Completion of recommended tests and referrals in telehealth vs in-person visits.

December 6, 2023

Authentic leadership at the Cleveland Clinic: psychological safety in the midst of crisis.

November 15, 2023

Anesthesia workspaces for safe medication practices: design guidelines.

November 15, 2023

Improving safety in the operating room: medication icon labels increase visibility and discrimination.

November 2, 2022

Intraoperative code blue: improving teamwork and code response through interprofessional, in situ simulation.

October 26, 2022

The impact of racism on child and adolescent health.

July 1, 2019

To err is human, but what happens when surgeons err?

September 28, 2022

The state of health, burnout, healthy behaviors, workplace wellness support, and concerns of medication errors in pharmacists during the COVID-19 pandemic.

August 23, 2023

Why stigma matters in addressing alcohol harm.

August 9, 2023

Association between electronic health record implementations and hospital-acquired conditions in pediatric hospitals.

August 2, 2023

Sociotechnical work system approach to occupational fatigue.

July 26, 2023

Physician and nurse well-being and preferred interventions to address burnout in hospital practice: factors associated with turnover, outcomes, and patient safety.

July 19, 2023

Postdischarge adverse events among neonates admitted to the neonatal intensive care unit.

September 7, 2022

Organisational failure: rethinking whistleblowing for tomorrow's doctors.

September 7, 2022

Analyzing and discussing human factors affecting surgical patient safety using innovative technology: creating a safer operating culture.

August 31, 2022

Comparing the variability of ingredient, strength, and dose form information from electronic prescriptions with RxNorm drug product descriptions.

August 31, 2022

Trial and error: learning from malpractice claims in childhood surgery.

August 24, 2022

Association between hospital acquired harm outcomes and membership in a national patient safety collaborative.

August 10, 2022

Disparities in adverse event reporting for hospitalized children.

August 3, 2022

Body mass index category and adverse events in hospitalized children.

July 27, 2022

July 20, 2022

Related Resources

Systemic failures in health care oversight.

March 20, 2024

Rapid expansion of the Healing Emotional Lives of Peers program during COVID-19: a second victim peer support program for healthcare professionals.

January 31, 2024

Addressing nursing shortages and patient safety using Maslow's hierarchy of needs.

January 10, 2024

Key factors for effective implementation of healthcare workers support interventions after patient safety incidents in health organisations: a scoping review.

January 10, 2024

A proposed approach to allegations of sexual boundary violation in health care.

December 13, 2023

Community Health Systems’ ongoing journey to zero preventable harm.

December 6, 2023

Interview

In Conversation with... Cheryl Jones about Addressing Workplace Violence and Creating a Safer Workplace

October 31, 2023

Perspectives on Safety

Addressing Workplace Violence and Creating a Safer Workplace

October 31, 2023

Right Kind of Wrong: Why Learning to Fail can Teach us to Thrive.

October 18, 2023

Why admitting to mistakes can help doctors (and patients).

October 4, 2023

Patient safety: listen to whistleblowers.

September 27, 2023

Defining speaking up in the healthcare system: a systematic review.

September 20, 2023

In search of an international multidimensional action plan for second victim support: a narrative review.

September 13, 2023

Videos of simulated after action reviews: a training resource to support social and inclusive learning from patient safety events.

September 6, 2023

Mind the power gap: how hierarchical leadership in healthcare is a risk to patient safety.

August 30, 2023

Lessons for Work-Life Wellness in Academic Medicine: Parts 1-3.

July 26, 2023

Issues and complexities in safety culture assessment in healthcare.

July 19, 2023

An integrative systematic review of employee silence and voice in healthcare: what are we really measuring.

June 28, 2023

'Speaking Up' for patient safety and staff well-being: a qualitative study.

June 7, 2023

Managing near-miss reporting in hospitals: the dynamics between staff members’ willingness to report and management’s handling of near-miss events.

June 7, 2023

VHA's movement for change: implementing high-reliability principles and practices.

May 31, 2023

Comparing perspectives on organisational silence: an analysis of the Gosport inquiry.

May 17, 2023

Roadmap to Health Care Safety for Massachusetts.

May 3, 2023

CHaMP: A model for building a center to support health care worker well-being after experiencing an adverse event.

April 5, 2023

A decade after Francis: is the NHS safer and more open?

April 5, 2023

Teamwork is associated with reduced hospital staff burnout at military treatment facilities: findings from the 2019 Department of Defense Patient Safety Culture Survey.

March 22, 2023

NHS staff cried in safety interviews, says watchdog.

March 8, 2023

A systems analysis of work-related violence in hospitals: stakeholders, contributory factors, and leverage points.

February 22, 2023

Speaking up as an extension of socio-cultural dynamics in hospital settings: a study of staff experiences of speaking up across seven hospitals.

February 22, 2023

Patient safety culture: the impact on workplace violence and health worker burnout.

February 8, 2023

See More About The Topic

Medicine

Nurse Care

Psychological and Social Complications

Culture of Safety

Safety paradoxes and safety culture.

Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Safety paradoxes and safety culture.

Pharmacist-led mobile health intervention and transplant medication safety: a randomized controlled clinical trial.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site