• Megha Karkera Kanjia, C Dean Kurth, Daniel Hyman, Eric Williams, and Anna Varughese.
• Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
• Anesthesiology. 2024 Nov 1; 141 (5): 835848835-848.

AbstractDuring the past 70 years, patient safety science has evolved through four organizational frameworks known as Safety-0, Safety -1, Safety-2, and Safety-3. Their evolution reflects the realization over time that blaming people, chasing errors, fixing one-offs, and regulation would not create the desired patient safety. In Safety-0, the oldest framework, harm events arise from clinician failure; event prevention relies on better staffing, education, and basic standards. In Safety-1, used by hospitals, harm events arise from individual and/or system failures. Safety is improved through analytics, workplace culture, high reliability principles, technology, and quality improvement. Safety-2 emphasizes clinicians' adaptability to prevent harm events in an everchanging environment, using resilience engineering principles. Safety-3, used by aviation, adds system design and control elements to Safety-1 and Safety-2, deploying human factors, design-thinking, and operational control or feedback to prevent and respond to harm events. Safety-3 represents a potential way for anesthesia and perioperative care to become safer.Copyright © 2024 American Society of Anesthesiologists. All Rights Reserved.

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