The causes of patient safety failure are system-wide, so we need to think that way. The causes are also to do with people, so we use and propose human factors thinking to understand them. Medical and care decisions are important and need to be right; they need to be based on facts. And so we base our thinking and conclusions on firm evidence.
Evidence shows that systemic action across a number of inter-related activities is needed to make patients safer. Hence, our action plan for safer care comprises six inter-related themes, namely: