From the Literature: Safety Overview Proceedings Published

Vincent C and deMol B (eds.) Safety in Medicine. Pergamon Press. 2000. ISBN 0-08045-6560

by Lorri A. Zipperer

Patient safety is complicated. To make changes, a complex system must be altered through complex methods. The health care system is multifaceted and layered—simple solutions for change aren’t always available. The study of safety in general also involves a variety of considerations—it doesn’t draw from strictly parallel lines and models. Bringing together the minds from both these different fields must be done to uncover new ways of looking at the safety issue within health care.

Similar to the National Patient Safety Foundation’s publication "A Tale of Two Stories," this volume is based on a multidisciplinary workshop on risk and safety in medicine. The 1998 meeting Safety in Medicine was convened by NeTWork, an international interdisciplinary study group that has set itself with the task of looking at how modern technologies—as they invade the work environment—create social and scientific problems. NeTWork’s pursuit of safety is intellectual and cathartic. The members of NeTWork who served as both coordinators for the workshop and contributors to Safety in Medicine are drawn from this bank of seasoned observers whose energies are focused on a solid, international base of safety studies. This philosophy supports their thoughts and work and is reflected in a worldwide and cross-fertilization sensibility in their contributions to the book.

The stated goal of both Safety in Medicine and the workshop "was to explore the differences and parallels between safety in health care and other domains." Editors Vincent and deMol have presented this material in an educational manner. It reflects sensitivity to a wide range of perspectives. The editors take the time to provide some background on the concepts explored by their contributors, while assuming a certain level of sophistication and awareness of the issue in their readers. They define risk—and its management—and discuss societal issues in general that impact safety improvement in medicine. The editors—almost in response to parallels often in the media between patient safety and aviation safety—outline the difficulties in applying to medicine lessons from safety programs and philosophies in other domains.

Opportunities for cross-disciplinary learning and sharing do exist in this arena and are highlighted in the text. The recognition of problems common to both medicine and other high-risk domains, such as incident reporting and analysis, underscore the need to consider safety very broadly in order to focus on organizational learning and not on individual blame. These commonalties are represented in four themes that run through the various chapters: 1) defining safety management; 2) investigating the nature and frequency of system problems; 3) analyzing what happens and the risks involved; and 4) improving safety and reducing risk.

The specific chapter subjects and the authors involved may be familiar to a student of patient safety. Jens Rasmussen, Charles Vincent and their colleagues tackle safety and medicine by looking at organizational management and psychological approaches. Sven Staender reviews both the effective and problematic collection and use of accident data, his discussion drawn from experience within the specialty of anesthesia. Sue Bogner and Sally Taylor-Adams outline human factors and systems methodologies that utilize data effectively in the health care environment. Other contributors approach specific projects exploring safety activities in distinct medical domains.

The final section of the book communicates a vision for the future. A concrete analysis of health valve failures sets the stage for a discussion of the ineffectiveness of regulation as a pathway to safety. Building on that, the anticipation of problems through the successful application of technology is discussed. Parallels from the chemical industry’s approach to regulation for safety’s sake to medicine today are drawn. The volume closes with a review of the actual workshop and how it, along with the book, examined key areas for future emphasis in medical error reduction work through practice and research within medicine.

One final comment on an intriguing and educational volume: good information is made all the more available through thoughtful and complete finding tools. The book deserves editorial consistency to make it credible. Safety in Medicine warranted professional editorial attention, including appropriate indexing of the book with special attention to the detail required to effectively map out the complex concepts in the volume. The ideas here deserve to be found easily by readers as they further explore and articulate the complex issues involved in patient safety.

Lorri A. Zipperer was the Information Projects Manager at the National Patient Safety Foundation from 1996 to 2000. During that time, she was the editor of Focus on Patient Safety, a Tale of Two Stories. She is currently the medical cybrarian at Medscape and can be reached by e-mail at: zipperer_info@altavista.com.