Hazardous healthcare

Safety lesson revisited: hazardous healthcare

From a systems perspective, it is important to understand which systems we are talking about, and put any statistical comparison in such perspective. For example, the following image by the NHS Institute for Innovation and Improvement shows how hazardous healthcare is when compared against, for example, bungee jumping and aviation:


However, if we were to divide those activities or sectors according to their potential for catastrophe, we could form two groups. One group collates those activities that pose potential risk to individual users but not so much to a social system at large: bungee jumping and healthcare, for example. Adverse events in this group are rather localized accidents. The other group is made of sectors and activities that pose greater risk to social systems. Adverse events are rather catastrophes and put great strains on a system, even to the point of collapsing it (eg, Chernobyl).


In above division we can observe that sectors or activities that appear as hazardous (such as healthcare), also tend to be less catastrophic and, thus, have a rather individual impact: medical errors and accidents do not cripple a hospital to the point of collapse. This lack of catastrophic consequences may also account for accidental death being more socially acceptable, and for healthcare safety to be less prominent as a social concern. This would also explain why driving, which kills more people than flying, is also a less prominent social concern than, for example, nuclear ships on NZ harbors.

Alternatively, if we were to divide those activities or sectors according to total lives lost per year, we can observe that the greatest death toll is carried by sectors and activities engaged by a larger proportion of the population and, even, on a more frequent basis. More people drive or require health care more often than people that fly or work in the chemical or nuclear industries.


In this second division of the figure we can observe that sectors or activities which people engage more with are also the riskiest and, yet, also show a less prominent social or individual concern: fewer people engage in bungee jumping and, those who do, probably show a greater concern for their individual safety before jumping than when they drive to the event or go to a hospital.

Healthcare safety may portrayed as poor, and a big emphasis (and blame) may be placed on healthcare professionals and healthcare systems. However, this perception of healthcare safety and safety culture may not be fully warranted. Nuclear and chemical industries and mass transport systems are safer because they have received greater attention and resources in lieu of their catastrophic potential, greater social concern and lesser familiarity with.

In summary, healthcare may not be as safe as it could, but it cannot simply be compared against aviation or other of the 'safe' activities or sectors. The closest comparable activity in regards to social concern and resources seems to be driving. If we could thus argue that healthcare and, for example, aviation are not comparable in their safety outcomes, is it possible that they are not comparable in regards to other outputs and processes, as well?

Want to know more?

Swiss-cheese model Transport safety statistics


Jose D PEREZGONZALEZ (2011). Massey University, New Zealand (JDPerezgonzalezJDPerezgonzalez).

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