A framework for integrated safety in safety-management systems in healthcare

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Vella Bonanno, Patricia and Srulovici, Einav and Mira, José Joaquín and Strametz, Reinhard and Tella, Susanna and Marinkovic, Valentina and Rafaeli, Anat and Tumelty, Mary Elizabeth and Pitz, Andreas and Guerra Paiva, Sofia and Venesoja, Anu and Buttigieg, Sandra C. (2025) A framework for integrated safety in safety-management systems in healthcare. International Journal of Health Governance, 30 (4). pp. 436-450. ISSN 2059-464X (https://doi.org/10.1108/ijhg-06-2025-0089)

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Abstract

Purpose Notwithstanding increased patient safety initiatives, adverse events and their impact on those involved continue. The strategic approaches adopted to manage safety by other high-intensity, high-risk and complex industries, such as aviation, have led to an increase in the systems approach for safety management in healthcare organisations. Professional expertise from members of the European Researchers’ Network for Second Victims (ERNST) highlighted that safety and the second victim phenomenon are interconnected across the healthcare ecosystem, extending beyond individual healthcare organisations. Design/methodology/approach Evidence from different sources, mainly the literature and practitioner professional expertise, was iteratively aggregated and analysed using theoretical systems-based approaches to conceptualise a framework for integrated safety in safety management systems in health. Findings A cross-sectional view of the healthcare organisation affected by adverse events was presented as a baseline. The whole system (system levels) approach, representing the healthcare system at the micro-, meso- and macro-level, adapting the model for integrated care, was then adopted. A safety-generating culture was considered to integrate and network across the levels of the healthcare system. The “system” (processes) approach, also considering external factors, was incorporated. This iterative conceptualisation led to a proposed framework for integrated safety. This framework was applied to systematically make recommendations for actions to support safety across the healthcare ecosystem. Originality/value Aggregation of evidence from the literature, together with expertise from professionals and iterative conceptualisation across models adopting the systems approach, led to a comprehensive framework for integrated safety in safety-management systems.

ORCID iDs

Vella Bonanno, Patricia ORCID logoORCID: https://orcid.org/0000-0002-6064-1323, Srulovici, Einav, Mira, José Joaquín, Strametz, Reinhard, Tella, Susanna, Marinkovic, Valentina, Rafaeli, Anat, Tumelty, Mary Elizabeth, Pitz, Andreas, Guerra Paiva, Sofia, Venesoja, Anu and Buttigieg, Sandra C.;
CORE (COnnecting REpositories)