Understanding safety in healthcare: the system evolution, erosion and enhancement model

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  • Jane Carthey
    Jane Carthey Consulting, London, United Kingdom


The paper summarises previous theories of accident causation, human error, foresight, resilience and system migration. Five lessons from these theories are used as the foundation for a new model which describes how patient safety emerges in complex systems like healthcare: the System Evolution Erosion and Enhancement model. It is concluded that to improve patient safety, healthcare organisations need to understand how system evolution both enhances and erodes patient safety.


safety, human error
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