Taking stock of the systems approach to patient safety

The application of concepts, theories and methods from systems ergonomics to the domain of patient safety has proved to be an expanding area of research and application in the last 15 years. This paper describes a review of the approach which aimed to identify: the main issues that have been researched; the types of methods of investigation adopted by researchers; the extent to which different system levels are covered; and, the types of medical domain in which work has gone on in the last few years. A total of 360 papers were selected for a detailed review. Approximately 16% of these focused on human error, followed by safety/error frameworks (13%), incident reporting (12%) and perceptions of safety/risk (9%). Most studies have addressed system concerns at the level of the individual (27%). The most frequent methodology used within research adopting the approach are case studies (33%). The findings from the review are discussed within the context of previous evaluations and criticisms of the systems approach and patient safety.