Safety-II and resilience: the way ahead in patient safety in anaesthesiology.
Anaesthesiology is a specialty with a remarkable track record regarding improvements in safety. Nevertheless, modern healthcare poses increasing demands on quality and outcome: more complexity, more patients with increasing risk-factors, more regulation from society concerning quality and outcome and finally more demand of the stakeholders for efficiency. This leads us to ask the question if our traditional way of handling 'risk' and 'safety' will stand the challenges of the future? Most of the success of modern anaesthesiology results from improved technology, pharmacology, training and education, improved systems, focus on human performance as well as standardization and development of guiding information. All of these aspects are crucial and have their relevance for well tolerated and modern practice. But despite all of these achievements, we must face the fact that we still cannot control complex processes by application of linear thinking (standardization). Modern risk-management concepts in other ultra-safe systems such as civil aviation or air traffic control introduced the concept of 'resilience' as well as 'safety-II' in order to deal with the challenges of increasing complex conditions. We are well advised to consider adapting these modern concepts of 'resilience' and 'safety-II' thinking when we want to substantially improve patient safety in anaesthesiology.