Vincent et al direct us to consider a different approach to help us to answer the question 'how safe is our care?' The difficulty, familiar to many healthcare professionals, is that we are conditioned to deal with risk and make good. For some, that ability to prevail in adversity will have defined their progression. It is culturally embedded in what we do. The problem in trying to improve safety is that it requires us to question that culture and re-consider our tolerance of risk. Doing so requires us to accept the hypothesis that sometimes, harm results from us operating with higher levels of risk than is good for our patients (so called normalised deviance).
In other words, restricting our view of safety by considering only reported episodes of harm, tells us less about the prevalence of unsafe conditions and perhaps more about how well we cope with them. If I were to walk across a road blindfolded, I might make it to the other side but clearly that does not mean it is a safe way to do it. Repeating it would probably end badly, sooner or later. The framework for the measurement and monitoring of safety directs us toward a broader view safety with a series of prompts to help us look beyond establishing the absence of harm towards ensuring the presence of safety.