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Can we have a culture of patient safety without one of staff safety?

BMJ 2011; 342 doi: (Published 04 March 2011) Cite this as: BMJ 2011;342:c6171
  1. Michael Sinnott, senior staff specialist and senior lecturer, Princess Alexandra Hospital and University of Queensland, Brisbane, Australia ,
  2. Ramon Z Shaban, senior research fellow, Griffith Health Institute, Griffith University and Princess Alexandra Hospital, Brisbane
  1. Correspondence to: michael_sinnott{at}

The history of patient safety

The patient safety movement reached its tipping point in 2000 after the publication, in the 1999 US Institute of Medicine Report, To Err is Human, of the extraordinary finding that there were up to 100 000 preventable deaths in US hospitals every year.1 The patient safety movement used James Reason’s paradigm of accident causation, the so called “Swiss Cheese Model”, to explain why systems failures cause most adverse events among patients, and identified the “no blame” culture as a way to improve outcomes among patients.2 Removing the fear of reporting errors means that systems failures can be identified and remedied before bad patient outcomes occur.

Despite the development of the no blame approach to patient safety, we have observed the opposite culture in relation to staff safety.

Observing a paradox: the scalpel versus the ampoule

While demonstrating two safety products to operating room nurses in the United States and Australia, one of the authors (MS) observed reactions that initially caused him concern. The first safety product was a new, sterile version of the popular single handed scalpel blade remover, which, when used with a hands free passing technique, can prevent up to 50% of all scalpel injuries.3 Scalpel injuries—the second most common cause of sharps injuries in the operating room—can cause infection with HIV, hepatitis B, C, and D, and other serious illnesses. They can also damage digital nerves, arteries, or tendons, requiring microsurgery and up to three months off work to undergo extensive rehabilitation. Psychosocial distress, inability to …

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