Publication
A framework for integrated safety in safety-management systems in healthcare
| Summary: | 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. |
|---|---|
| Main Authors: | Vella Bonanno, Patricia |
| Other Authors: | Srulovici, Einav; Mira, José Joaquín; Strametz, Reinhard; Tella, Susanna; Marinkovic, Valentina; Rafaeli, Anat; Tumelty, Mary Elizabeth; Pitz, Andreas; Guerra Paiva, Sofia; Venesoja, Anu; Buttigieg, Sandra C. |
| Subject: | Adverse events or outcomes Evidence-based practice Governance structures Health law or regulation Organizational development for effective clinical governance Patient safety Process mapping Public health regulations Safety culture Health Policy Public Health, Environmental and Occupational Health Strategy and Management Palaeontology SDG 3 - Good Health and Well-being |
| Year: | 2025 |
| Country: | Portugal |
| Document type: | article |
| Access type: | open access |
| Associated institution: | Universidade Nova de Lisboa |
| Language: | English |
| Origin: | Repositório Institucional da UNL |
| _version_ | 1868984235664080896 |
|---|---|
| author | Vella Bonanno, Patricia |
| author2 | Srulovici, Einav Mira, José Joaquín Strametz, Reinhard Tella, Susanna Marinkovic, Valentina Rafaeli, Anat Tumelty, Mary Elizabeth Pitz, Andreas Guerra Paiva, Sofia Venesoja, Anu Buttigieg, Sandra C. |
| author2_role | author author author author author author author author author author author |
| author_facet | Vella Bonanno, Patricia Srulovici, Einav Mira, José Joaquín Strametz, Reinhard Tella, Susanna Marinkovic, Valentina Rafaeli, Anat Tumelty, Mary Elizabeth Pitz, Andreas Guerra Paiva, Sofia Venesoja, Anu Buttigieg, Sandra C. |
| author_role | author |
| contributor_name_str_mv | Centro de Investigação em Saúde Pública (CISP/PHRC) Comprehensive Health Research Centre (CHRC) - Pólo ENSP Escola Nacional de Saúde Pública (ENSP) Associação Portuguesa para o Estudo do Quaternário (APEQ) RUN |
| country_str | PT |
| creators_json_txt | [{\"Person.name\":\"Vella Bonanno, Patricia\"},{\"Person.name\":\"Srulovici, Einav\"},{\"Person.name\":\"Mira, José Joaquín\"},{\"Person.name\":\"Strametz, Reinhard\"},{\"Person.name\":\"Tella, Susanna\"},{\"Person.name\":\"Marinkovic, Valentina\"},{\"Person.name\":\"Rafaeli, Anat\"},{\"Person.name\":\"Tumelty, Mary Elizabeth\"},{\"Person.name\":\"Pitz, Andreas\"},{\"Person.name\":\"Guerra Paiva, Sofia\"},{\"Person.name\":\"Venesoja, Anu\"},{\"Person.name\":\"Buttigieg, Sandra C.\"}] |
| datacite.contributors.contributor.contributorName.fl_str_mv | Centro de Investigação em Saúde Pública (CISP/PHRC) Comprehensive Health Research Centre (CHRC) - Pólo ENSP Escola Nacional de Saúde Pública (ENSP) Associação Portuguesa para o Estudo do Quaternário (APEQ) RUN |
| datacite.creators.creator.creatorName.fl_str_mv | Vella Bonanno, Patricia Srulovici, Einav Mira, José Joaquín Strametz, Reinhard Tella, Susanna Marinkovic, Valentina Rafaeli, Anat Tumelty, Mary Elizabeth Pitz, Andreas Guerra Paiva, Sofia Venesoja, Anu Buttigieg, Sandra C. |
| datacite.date.Accepted.fl_str_mv | 2025-11-01T00:00:00Z |
| datacite.date.available.fl_str_mv | 2026-03-16T15:36:02Z |
| datacite.date.embargoed.fl_str_mv | 2026-03-16T15:36:02Z |
| datacite.rights.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| datacite.subjects.subject.fl_str_mv | Adverse events or outcomes Evidence-based practice Governance structures Health law or regulation Organizational development for effective clinical governance Patient safety Process mapping Public health regulations Safety culture Health Policy Public Health, Environmental and Occupational Health Strategy and Management Palaeontology SDG 3 - Good Health and Well-being |
| datacite.titles.title.fl_str_mv | A framework for integrated safety in safety-management systems in healthcare |
| dc.contributor.none.fl_str_mv | Centro de Investigação em Saúde Pública (CISP/PHRC) Comprehensive Health Research Centre (CHRC) - Pólo ENSP Escola Nacional de Saúde Pública (ENSP) Associação Portuguesa para o Estudo do Quaternário (APEQ) RUN |
| dc.creator.none.fl_str_mv | Vella Bonanno, Patricia Srulovici, Einav Mira, José Joaquín Strametz, Reinhard Tella, Susanna Marinkovic, Valentina Rafaeli, Anat Tumelty, Mary Elizabeth Pitz, Andreas Guerra Paiva, Sofia Venesoja, Anu Buttigieg, Sandra C. |
| dc.date.Accepted.fl_str_mv | 2025-11-01T00:00:00Z |
| dc.date.available.fl_str_mv | 2026-03-16T15:36:02Z |
| dc.date.embargoed.fl_str_mv | 2026-03-16T15:36:02Z |
| dc.format.none.fl_str_mv | application/pdf |
| dc.identifier.none.fl_str_mv | http://hdl.handle.net/10362/201474 |
| dc.language.none.fl_str_mv | eng |
| dc.rights.none.fl_str_mv | http://purl.org/coar/access_right/c_abf2 |
| dc.subject.none.fl_str_mv | Adverse events or outcomes Evidence-based practice Governance structures Health law or regulation Organizational development for effective clinical governance Patient safety Process mapping Public health regulations Safety culture Health Policy Public Health, Environmental and Occupational Health Strategy and Management Palaeontology SDG 3 - Good Health and Well-being |
| dc.title.fl_str_mv | A framework for integrated safety in safety-management systems in healthcare |
| dc.type.none.fl_str_mv | http://purl.org/coar/resource_type/c_6501 |
| description | 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. |
| dirty | 0 |
| eu_rights_str_mv | openAccess |
| format | article |
| fulltext.url.fl_str_mv | https://run.unl.pt/bitstreams/24c0ea81-47e0-4074-b446-6642a1960e52/download |
| id | run_32f6aa45f91c4e863e7a72cd9369a780 |
| identifier.url.fl_str_mv | http://hdl.handle.net/10362/201474 |
| inst_facet_str | urn:organizationAcronym:unl{{{_:::_}}}Universidade Nova de Lisboa |
| instacron_str | unl |
| institution | Universidade Nova de Lisboa |
| instname_str | Universidade Nova de Lisboa |
| language | eng |
| network_acronym_str | run |
| network_name_str | Repositório Institucional da UNL |
| oai_identifier_str | oai:run.unl.pt:10362/201474 |
| organization_str_mv | urn:organizationAcronym:unl |
| person_str_mv | Vella Bonanno, Patricia Srulovici, Einav Mira, José Joaquín Strametz, Reinhard Tella, Susanna Marinkovic, Valentina Rafaeli, Anat Tumelty, Mary Elizabeth Pitz, Andreas Guerra Paiva, Sofia Venesoja, Anu Buttigieg, Sandra C. |
| publishDate | 2025 |
| repo_facet_str | urn:repositoryAcronym:run{{{_:::_}}}Repositório Institucional da UNL |
| reponame_str | Repositório Institucional da UNL |
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| service_str_mv | urn:repositoryAcronym:run |
| spelling | engenPurpose – 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.application/pdfenA framework for integrated safety in safety-management systems in healthcareVella Bonanno, PatriciaSrulovici, EinavMira, José JoaquínStrametz, ReinhardTella, SusannaMarinkovic, ValentinaRafaeli, AnatTumelty, Mary ElizabethPitz, AndreasGuerra Paiva, SofiaVenesoja, AnuButtigieg, Sandra C.Centro de Investigação em Saúde Pública (CISP/PHRC)Comprehensive Health Research Centre (CHRC) - Pólo ENSPEscola Nacional de Saúde Pública (ENSP)Associação Portuguesa para o Estudo do Quaternário (APEQ)HostingInstitutionOrganizationalRUNe-mailmailto:run@unl.ptrun@unl.ptISSNIsPartOf2059-4631URNIsPartOfPURE: 157625413URNIsPartOfPURE UUID: 08ba1fe5-5892-4af5-8bbd-ce619564cce3URNIsPartOfScopus: 105024458059URNIsPartOfWOS: 001603172400001DOIIsPartOf10.1108/IJHG-06-2025-00892026-03-16T15:36:02Z2025-112025-11-01T00:00:00ZHandlehttp://hdl.handle.net/10362/201474http://purl.org/coar/access_right/c_abf2open accessAdverse events or outcomesEvidence-based practiceGovernance structuresHealth law or regulationOrganizational development for effective clinical governancePatient safetyProcess mappingPublic health regulationsSafety cultureHealth PolicyPublic Health, Environmental and Occupational HealthStrategy and ManagementPalaeontologySDG 3 - Good Health and Well-being2806229 bytesliteraturehttp://purl.org/coar/resource_type/c_6501journal articlehttp://purl.org/coar/access_right/c_abf2application/pdffulltexthttps://run.unl.pt/bitstreams/24c0ea81-47e0-4074-b446-6642a1960e52/download |
| spellingShingle | A framework for integrated safety in safety-management systems in healthcare Vella Bonanno, Patricia Adverse events or outcomes Evidence-based practice Governance structures Health law or regulation Organizational development for effective clinical governance Patient safety Process mapping Public health regulations Safety culture Health Policy Public Health, Environmental and Occupational Health Strategy and Management Palaeontology SDG 3 - Good Health and Well-being |
| status | SINGLETON |
| subject.fl_str_mv | Adverse events or outcomes Evidence-based practice Governance structures Health law or regulation Organizational development for effective clinical governance Patient safety Process mapping Public health regulations Safety culture Health Policy Public Health, Environmental and Occupational Health Strategy and Management Palaeontology SDG 3 - Good Health and Well-being |
| title | A framework for integrated safety in safety-management systems in healthcare |
| title_full | A framework for integrated safety in safety-management systems in healthcare |
| title_fullStr | A framework for integrated safety in safety-management systems in healthcare |
| title_full_unstemmed | A framework for integrated safety in safety-management systems in healthcare |
| title_short | A framework for integrated safety in safety-management systems in healthcare |
| title_sort | A framework for integrated safety in safety-management systems in healthcare |
| topic | Adverse events or outcomes Evidence-based practice Governance structures Health law or regulation Organizational development for effective clinical governance Patient safety Process mapping Public health regulations Safety culture Health Policy Public Health, Environmental and Occupational Health Strategy and Management Palaeontology SDG 3 - Good Health and Well-being |
| topic_facet | Adverse events or outcomes Evidence-based practice Governance structures Health law or regulation Organizational development for effective clinical governance Patient safety Process mapping Public health regulations Safety culture Health Policy Public Health, Environmental and Occupational Health Strategy and Management Palaeontology SDG 3 - Good Health and Well-being |
| url | http://hdl.handle.net/10362/201474 |
| visible | 1 |