Historically, health care has approached safety with a Safety-I lens, emphasizing the prevention of errors and investigating failures. While this method remains significant, contemporary health care’s complex, dynamic, and interdependent nature necessitates proactive and adaptive safety strategies. The emerging Safety-II and Safety-III frameworks provide novel perspectives on safety by prioritizing resilience, real-time adaptation, and learning from success, rather than from failure.
Safety-II shifts the focus from what goes wrong to what goes right. It acknowledges that most health care processes are successful daily, despite the inherent risks and system variability. Safety-II evaluates successful outcomes to comprehend why processes function effectively under duress. It creates systems that are not only rule-bound but also resilient and adaptable. This helps us to improve adaptive capacity and how clinicians react to unpredictable events. Therefore, health systems must establish adaptable protocols to handle future crises by incorporating the knowledge gained from these adaptive responses.
Safety-III augments Safety-II by incorporating anticipatory safety, which employs data, predictive analytics, and real-time monitoring to avert damage before it occurs. It is closely aligned with high-reliability organization principles and contemporary digital health capabilities. Safety-III uses predictive data analytics (AI, big data) to anticipate hazards and implement early interventions. It encourages the establishment of ongoing learning channels between leadership action and frontline observations. We can leverage it to incorporate human factors engineering to develop safer workflows. Indeed, Safety-III transforms safety from a reactive function to a real-time, proactive system that is seamlessly integrated into daily operations.
Combining Safety-II and Safety-III reframes health care safety from an error-focused discipline to a resilience-focused and anticipatory practice. This enables holistic learning since it captures both what prevents harm and what ensures success. We can implement it by engaging frontline staff and encouraging reporting of positive deviations (workarounds that improve care) alongside incident reports. Health care leaders must demonstrate commitment by promoting a just and learning-oriented culture that values adaptation and foresight. We should invest in technology by leveraging AI, machine learning, and real-time dashboards to support predictive safety initiatives. Continuous feedback loops could involve daily safety huddles and debriefs to capture insights from routine and exceptional events.
In the increasingly complex health care environment, health systems can transform safety into a dynamic, proactive system that prevents damage and promotes innovation, trust, and high-quality care by studying success, anticipating risk, and embedding adaptability. A stronger safety culture will encourage staff to share innovations and insights, not just errors. Proactive risk management must incorporate predictive tools to anticipate harm while learning from daily clinical successes. Indeed, health care organizations must enhance resilience by building frameworks or systems that adapt to uncertainty rather than collapse under pressure.
Olumuyiwa Bamgbade is an accomplished health care leader with a strong focus on value-based health care delivery. A specialist physician with extensive training across Nigeria, the United Kingdom, the United States, and South Korea, Dr. Bamgbade brings a global perspective to clinical practice and health systems innovation.
He serves as an adjunct professor at academic institutions across Africa, Europe, and North America and has published 45 peer-reviewed scientific papers in PubMed-indexed journals. His global research collaborations span more than 20 countries, including Nigeria, Australia, Iran, Mozambique, Rwanda, Kenya, Armenia, South Africa, the U.K., China, Ethiopia, and the U.S.
Dr. Bamgbade is the director of Salem Pain Clinic in Surrey, British Columbia, Canada—a specialist and research-focused clinic. His work at the clinic centers on pain management, health equity, injury rehabilitation, neuropathy, insomnia, societal safety, substance misuse, medical sociology, public health, medicolegal science, and perioperative care.
