Systematising safety: Developing integrated safety management systems in healthcare

Background After several decades of sustained effort, patient safety remains a difficult challenge. A range of policy interventions and organisational activities now focus on patient safety issues, but these are often developed as stand-alone interventions or are implemented in isolation. This contrasts to the approach taken in other safety-critical sectors, where safety is built on carefully organised and tightly integrated safety management systems (SMS) that bring together all the fundamental activities of understanding, implementing, monitoring and improving safety in organisations. Methods This article considers the organising principles that underpin SMS in a range of other sectors, and explores and describes the key functions and activities that are of particular relevance to healthcare. Strategies in other safety-critical sectors are reviewed, emerging thinking in healthcare is described and the relevance of policy and legislation are considered. Results SMS are the foundation of safety in sectors from aviation to food production, but healthcare does not yet have a well-specified and widely shared view on what constitute the fundamental principles, activities and functions necessary to support integrated systems of safety management. This critical issue is increasingly being recognised by national health agencies, and the journey towards developing integrated SMS in healthcare represents the next phase in the systemic improvement of patient safety. Conclusion The development of healthcare SMS can be informed by the experiences of safety-critical sectors that have travelled this path before; by emerging thinking and exploration in healthcare organisations; and by revisiting the legislative and policy context that shapes patient safety.