Conference: Safety 2 and beyond - Resilience meets regulation

Date: 4 June 2015, 9.30-17.00
Place: Erasmus University Rotterdam, van der Goot Building, Tokyo room, M1-17


Download the summary of the presentations and workshops.


Healthcare organizations are more than structures and guidelines; they are complex adaptive systems, full of self-organizing, rich relationships. Healthcare practices cannot exist without improvising. Nonetheless, health policy and regulation seem to be predicated on a linear perspective where regulation is based on work as it is imagined (WAI) and not how it is done (WAD). Moreover, regulation focuses on what goes wrong in healthcare practices, instead of looking at what goes right and why.

Recognizing the limitations of this linear perspective, an important change has emerged in coping with safety in healthcare: a shift from safety 1 to safety 2. Whereas safety 1 is reactive, technocratic and focusses on events, safety 2 is proactive, focusses on actions, relations and things that go right. Safety 2 downplays the emphasis on standards, and evidence-based systems and tries to understand safety as it is performed in everyday healthcare practices where healthcare workers create adaptive practical knowledge, a kind of knowledge that Aristotle framed long ago as ‘phronesis’.

In this seminar, we want to explore the new ways of thinking that Safety 2 has introduced, and go one step beyond, by focusing on what this new way of conceptualizing patient safety means for healthcare organizations and regulation. We explore the following questions:

  • How can we enact safety 2 in healthcare organizations and systems?
  • How can we design regulatory practices that take safety 2 seriously?
  • What role is there to play for the main actors in healthcare—professionals, organizations, patients, insurers and policy-makers?
  • Can we redesign the whole system and the roles of the stakeholders so they are focused on things going right as well as things going wrong?

Confirmed speakers

4 Key notes

  • Jeffrey Braithwaite, Macquarie University AUSTRALIA
  • Jessica Mesman, Maastricht University
  • Kieran Walshe, Manchester Business School UK
  • Roland Bal, Erasmus University Rotterdam

4 Workshops (in English or Dutch)

  • New forms of regulation (the inspection of things that go right)
    Renate Verkaik (Nivel), Annemiek Stoopendaal (Erasmus University Rotterdam), Chair Paul Robben (Dutch Healthcare Inspectorate)
  • Narrative & genarative accountability
    Gerdienke Ubels (Actiz), Sonja Jerak-Zuiderent (Lingköping University SWEDEN)
  • New practices and technology to enact resilience in governance
    Yolande Witman (Siza Zorggroep), Rob Hoogma (Siza Zorggroep)
  • 'Everyday life' accountability
    Ian Leistikow (Dutch Healthcare Inspectorate), Hester van de Bovenkamp (Erasmus University Rotterdam), Antoinette de Bont (Erasmus University Rotterdam)

Key Text: Resilient Health Care, Volume 1&2 Hollnagel E, Braithwaite J, Wears R (editors) (2013). Resilient Health Care. London: Ashgate. 978-1-4094-6978-0