Safety in healthcare is a moving target

Safety in healthcare is a constantly moving target. As standards improve and concern for safety grows, we come to regard an increasing number of events as patient safety issues. In this respect, healthcare differs from almost all other safety-critical industries. What we regard as harm in, for instance, civil aviation remains the same whatever advances may occur in aviation technology or practice. In contrast, innovation and improving standards in healthcare alter our conceptions of both harm and preventability. In the 1950s, many complications of healthcare were recognised, at least by some, but largely viewed as the inevitable consequences of medical intervention.1 Over time, certain types of incidents come to be seen as both unacceptable and potentially preventable. The clearest example in recent times is healthcare-associated infections, which in the 1980s were still regarded as unfortunate, but inevitable. With increased understanding of underlying processes, mechanisms of transmission and methods of prevention, coupled with major public and regulatory pressure, such infections are now seen as patient safety issues.2 The list of ‘never events’ put forward in various countries, such as wrong-site surgery, is similarly an assertion that certain types of failure cannot be tolerated.3 In the last 10 years, as more types of harm have come to be regarded as preventable, the perimeter of patient safety has expanded. We could now include pressure ulcers, …