‘Safety’ as a Construct in Healthcare

‘SAFETY’ AS A CONSTRUCT IN HEALTHCARE

This dilemma with ‘errors’ in healthcare parallels problems associated with the use of the term ‘safety’ as it relates either to healthcare or to pharmacotherapy. Safety as a term in current usage generally implies an absolute state: healthcare being perceived to be either safe (free from danger or risk) or unsafe. In this customary usage of the term by the general public, the matter of how relatively unsafe a particular prac-tice is is usually not in question. Thus arguably, an unfortunate misnomer has been applied, and public concerns about ‘safety’ in healthcare as such can never be sufficiently addressed. Certainly the adoption of these terms ‘error’ and ‘safety’ with respect to issues in healthcare will continue to cause difficulty for those trying to make health services less likely to harm and also less error prone.

Very frequently, a sort of reciprocal of these terms ‘error’ and ‘safety’ is embodied in a much more complex and difficult-to-define concept of ‘quality’ in health care. At present, the quality-in-healthcare movement is gaining considerable currency, with countries such as the United States pouring very substantial resources into Quality Improvement Organisations as part of their publicly funded Medi-care system. The benefits from such systems at present remain controversial (Marciniak et al., 1998; Snyder and Anderson, 2005).

These semantic considerations around terms such as ‘error’, ‘safety’ and ‘quality’ are particularly relevant for those teaching and learning pharmacovigilance in the local clinical setting. Healthcare professionals in practice are generally acutely aware of their ability to both make and contribute to mistakes within the healthcare system, but they are also equally aware of their responsibilities to achieve healthcare quality and, in particular, to strive for the best balance between risk and benefit in all that they do to assist restoration of health to their patients.