Successful quality improvement (QI) initiatives should encourage change at the individual, team, and organizational levels. The authors of this article summarize the “self-limiting cascade” of quality improvement approaches, whereby QI programs prioritize process-technical strengths (e.g., quality metrics, “zero harm” goals) over participants’ emotional experience and sociotechnical design elements, which can ultimately hinder program performance.

Work-related psychosocial factors may increase or decrease the risk of accidents in high-risk industries (e.g., nuclear, mining, healthcare). Using the Job Demands-Resources (JD-R) framework as a starting point, associations between job demands and resources, and between safety behaviors and outcomes were evaluated. Most studies report on the link between psychosocial factors and safety behavior (e.g., job stress or exhaustion can precede negative safety behavior).

Safety strategies from high-reliability industries such as aviation and nuclear power are frequently adapted for healthcare. In this study, pilots described crisis preparedness strategies, which surgical safety experts then developed into a framework consisting of six behavioral interventions: anticipate threats, briefing, checklists, drill rehearsal, individual and team empowerment, and debriefing. An earlier study by the authors describes the second phase in managing crisis: crisis recovery.

Transparency, communication, and value alignment between staff and leaders increase staff trust and comfort in speaking up about concerns. This study describes the relationship of employees’ perception of ethical leadership (manager sets an example of ethical behavior), safety voice (comfort speaking up about COVID-19), ethical ambiguity regarding work responsibilities, and risk perception of coronavirus. Employees who rated their leaders as behaving more ethically were more comfortable speaking up about COVID-19 concerns.

Error management, as opposed to error avoidance, has been shown to improve transfer of skills from training to practice. This study compared two interventions to induce error management (direct or indirect encouragement to learn from errors) and error avoidance. As hypothesized, participants in the error management groups performed better, particularly those in the indirect error management intervention.

Some patient safety interventions, such as checklists, are adapted or borrowed from other industries, such as aviation. This literature review focused on safety interventions developed in one context then implemented in another, such as healthcare. Healthcare was the largest sector represented, with 20 of the 73 included studies.

Proficient safety professionals are the cornerstone of effective patient safety programs. In this study, safety professionals provided insights about theoretical factors influencing the role of safety professionals in healthcare (e.g., legal regulation, organizational context, safety culture).

Structural racism, from race-adjusted algorithms to biased machine learning, contributes to and exacerbates health inequities. This commentary calls for developing valid measures of structural racism and a publicly available data infrastructure for researchers. A related study examined the relationship between structural racism and birth outcomes between Black and white patients in Minnesota.