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System Safety in Healthcare
2016
Journal of System Safety
The popular theory that human error, such as making the wrong diagnosis, operating on the wrong body part or administering the wrong medication, in itself causes harm to patients may not always be completely true. According to system safety theory and the "Swiss Cheese" theory of healthcare, at least two things have to go wrong for harm to occur. Usually, the primary cause is a poorly designed care system that allows human errors to happen. Each weakness in the system is called a "hazard." A
doi:10.56094/jss.v52i2.123
fatcat:3ikc3b64hjdyzfl6nwxrnt4ymm