This article explores patient safety issues in remote primary care encounters through a comprehensive qualitative study integrating both Safety I and Safety II perspectives. The Safety I approach examines why safety incidents happen by analyzing 95 documented cases of harm or near-harm events, while Safety II focuses on how healthcare staff creatively adapt to prevent such incidents despite systemic challenges.
The study highlights that although safety incidents in remote care are rare, when they occur, they often stem from inappropriate use of remote modalities, poor communication, limited clinical assessment, and system-level factors such as understaffing, high demand, and complex triage pathways. Common consequences include missed, delayed, or incorrect diagnoses, and inadequate follow-up, particularly impacting vulnerable patients with complex conditions, communication barriers, or urgent symptoms.
Key findings emphasize that remote consultations—mostly by telephone—limit sensory information (visual, tactile cues), making thorough clinical assessment difficult. This limitation frequently leads to insufficient history-taking and reliance on inappropriate algorithms or third-party reports, increasing risk. The research also reveals that fragmented care due to task distribution among various clinical and non-clinical staff adds complexity and potential for error.
Despite these challenges, frontline staff employ situational judgment, initiative, and informal safety practices to mitigate risks. Examples include switching from phone to video calls when visual assessment is critical, prioritizing urgent cases beyond rigid protocols, and home visits for patients who do not engage remotely. Such adaptive behaviors underpin a culture of safety in a strained primary care context.
The study concludes that to maintain and enhance safety as remote care becomes routine, comprehensive staff training on risks and mitigation strategies is vital. Additionally, recognition and support of frontline staff’s creative problem-solving should be integrated into organizational policies. The authors underscore that remote care, when appropriately used and supported, can coexist safely with in-person services but demands continuous attention to its unique risks.
Note: Safety I and Safety II are two complementary approaches to understanding and improving safety in healthcare and other complex systems.
Safety I focuses on what goes wrong. It studies incidents, errors, and failures by analyzing adverse events to identify root causes and safety gaps. The goal is to prevent recurrence by tightening rules, protocols, and procedures. This approach treats safety as the absence of harm, emphasizing error detection and correction.
Safety II, in contrast, focuses on why things usually go right. It examines everyday work and how individuals and teams adapt creatively to changing, uncertain conditions to maintain safety. Instead of only reacting to failures, Safety II studies successful practices and resilience, recognizing that safety depends on human flexibility, initiative, and context-specific judgment. This approach views safety as the presence of capacity to succeed under varying conditions.
In summary, Safety I seeks to reduce harm by preventing errors, while Safety II aims to enhance safety by understanding and supporting adaptive, successful performance in complex environments. Combining both approaches provides a fuller picture of safety dynamics and informs better interventions.
Reference:
Payne, R., Clarke, A., Swann, N., et al. (2024). Patient safety in remote primary care encounters: multimethod qualitative study combining Safety I and Safety II analysis. BMJ Quality & Safety, 33(7), 573–586. https://doi.org/10.1136/bmjqs-2023-016674
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