Safety 3.0 and the End of the Superstar Clinician

  • Chris P. Subbe
  • Paul Barach


Training of clinicians in both nursing and medicine is often focused on improving their individual competencies in the hope to reduce error and patient harm rates to a negligible level. Medicine attracts the brightest students in most countries through a highly competitive selection process. Despite this, 5–10% of patients admitted to hospital continue to suffer complications with significant morbidity and mortality. Disappointingly error rates in many areas have not significantly changed for decades.

The dominant philosophies of error reduction are ‘Safety 1’ and ‘Safety 2’. The principle of ‘Safety 1’ focuses on measurement and understanding of errors. ‘Safety 2’ is looking for resilient systems in which we seek to understand how people manage to create safety despite system weaknesses and endeavour to better appreciate successful safe working practices.

In this chapter in build on Safety 1 and 2, and introduce the concept of Safety 3.0. In contrast to the principles applied to reducing errors in hospitals, the high-reliability industries have used another approach to assure reliable, reduction of failures and to enhance safety: modular redundancy. This approach assures that safety-critical parts of technical systems exist in triplicate or quadruplicate backups and the failure of individual parts does not lead to catastrophic system failures and fatal outcomes. This might be the key to reliable safety of complex social-technical systems such as aviation, nuclear power, space travel and more.

The application of this principle is still rare in healthcare, but acceptance of the need for a robust safety management system based on redundancy of safety-critical steps in medical processes and distributive models of governance might improve error rates, reduce patient harm and enhance clinical outcomes. Patient involvement is essential as an equal partner in the co-design of robust safety in healthcare and key to achieving the triple aims goals of safe, effective and patient-centred care.


Mistakes Errors Failures Patient safety Patient-centred Healthcare Hierarchy Co-production 


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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Chris P. Subbe
    • 1
  • Paul Barach
    • 2
  1. 1.Bangor UniversityBangorUK
  2. 2.Wayne State UniversityDetroitUSA

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