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‘The Quiet Revolution in QI: Safety-II and the Return of Practical Expertise’ – Andrew Smaggus and Suzette Woodward

An overview of the major transformation currently taking place in QI.

11 Feb 2020
13:00 – 14:00

In this session, Canadian health researcher Andrew Smaggus shared his clear-sighted and challenging overview of the major transformation currently taking place in QI, as described in his recent BMJ Quality and Safety article, ‘Safety-I, Safety-II and burnout: how complexity science can help clinician wellness’ (closed access, but Q members can access for free).

Followed by a brief conversation with a leading UK voice in patient safety and Safety-II, Suzette Woodward, and a Q&A.

Watch the webinar

Download Andrew’s slides

More information and resources from the webinar

It has been 20 years since the US Institute of Medicine’s report To Err is Human brought the issues of medical error and patient harm due to healthcare into the mainstream. The ensuing quality and safety movement has had a transformative effect on healthcare, producing innovations in patient care, an active scholarly community, and genuine efforts to involve the public in the ongoing evolution of care delivery.

However, the past 20 years have also seen a growing crisis of clinician burnout.  Despite rhetoric emphasising ‘quadruple aims’, flattening hierarchies, and creating a ‘just culture’, current clinicians are finding joy and meaning in work more and more elusive.

Could it be that the increased attention to healthcare quality and patient safety is related to the growing rates of burnout on the frontlines?  Are the methods healthcare employs to pursue greater quality and safety marginalising something essential in the work that doctors, nurses, therapists, and other frontline professionals do?  If so, how do we restore the missing element while still advancing the quality and safety of healthcare?

Andrew uses ‘Appreciative Inquiry’ as an illustrative example of a Safety-II approach that draws on complexity sciences and focuses on creating success rather than eliminating failure: ‘a system pre-occupied with its failures may be blind to how it achieves its success’.

Read more about patient safety and Safety-II

  • ‘Resilient health care: turning patient safety on its head‘ (5 pages) by Jeffrey Braithwaite, Robert Wears and Erik Hollnagel
  • From Safety-I to Safety-II: A White Paper’ (40 pages)  by Jeffrey Braithwaite, Robert Wears and Erik Hollnagel
  • Still Not Safe: Patient Safety and the Middle-Managing of American Medicine, (2020) by Robert Wears and Kathleen Sutcliffe
  • Compassionomics: The Revolutionary Scientific Evidence that Caring Makes a Difference’ (2019) by Stephen Trzeciak, Anthony Mazzarelli
  • Rethinking Patient Safety (2017), by Suzette Woodward
  • Implementing Patient Safety – addressing culture, conditions and values to help people work safely (2019) by Suzette Woodward
  • Safety II Behavior in a Pediatric Intensive Care Unit’ by Jenna Merandi, Kathryn Vannatta, J. Terrance Davis, Richard E. McClead, Richard Brilli and Thomas Bartman

Want to keep the conversation going? Join the Safety-II inspired ‘Learning from Excellence‘ Special Interest Group (all welcome). We plan to share some Q members’ inspiring ‘Learning from Excellence’ projects over Zoom in the coming months – details will appear in that SIG.

‘Learning from Excellence’ is an innovation that focuses on capturing and learning from episodes of excellence in healthcare in an attempt to further improve the quality and safety of care that we provide. This group offers the opportunity to share ideas, experience, support, innovations and learning from what has gone well and what has been challenging.


Andrew Smaggus
Andrew’s interest in patient safety and healthcare quality began during his training in medicine.  He completed medical school and postgraduate training (internal medicine) at the University of Toronto.  Early in his career as a physician, he completed a Masters degree in Healthcare Quality and Safety at Queen’s University, and participated in a variety of quality and safety efforts.  He subsequently developed an interest in Morbidity and Mortality Rounds, which led to his introduction to resilience engineering, Safety-II, and complexity science.  In his PhD he explores how complexity science can inform efforts to enhance healthcare quality and patient safety.


Suzette Woodward
Suzette is an internationally renowned expert in patient safety, who worked in the NHS for 40 years, as a general nurse at St Thomas’ Hospital and a paediatric intensive care nurse at Guy’s Hospital. For the last five years she was the National Clinical Director for the Sign up to Safety Campaign. She is also a Visiting Professor for the Institute of Global Health Innovation at Imperial College University London. Her main area of interest and research relates to translating policy into action and the implementation of a just culture and Safety II. She is the author of two books, Rethinking Patient Safety and Implementing Patient Safety.


To find out more about Suzette, visit her website.