If we believe in Normal Accident Theory (NAT) should we focus on prevention but also expect failure ?
NAT and the BP oil spill excerpt from Culturing Science blog:
“We are all human. We all know what it’s like to procrastinate, to forget to leave a message, to have our minds wander. In his book, Chiles argues, citing over 50 examples in immense detail, that most disasters are caused by “ordinary mistakes” – and that to live in this modern world, we have to “acknowledge the extraordinary damage that ordinary mistakes can now cause.” Most of the time, things run smoothly. But when they don’t, our culture requires us to find someone to blame instead of recognizing that our own lifestyles cause these disasters. Instead of reconsidering the way we live our lives, we simply dump our frustration off so that we can continue living our lives in comfort (Waters, 2010).”
Where is the best place to direct resources to truly improve safety? (continued…)
We want to prevent falls but should hospitals expect that despite our best human or technological efforts patients will fall and therefore invest in a soft flooring like cork or padded furniture or surfaces?
If we try and reduce the number of central line days to decrease infection will some patients experience more complications from peripheral IVs or suboptimal treatment? If we expect failure or unforeseen interactions and consequences can we monitor for these from the outset? Otherwise we might only know there is a problem after a disaster occurs. The most dangerous thinking to have is “it can’t happen here” or “I would never do something like that.”
Safety Dog's Blog 
A challenge i see is in knowing the most effective method to prevent an accident. And does one method work for all people and for all situations.
Playgrounds are a tangible example – to make them safer for kids (who are going to fall – in fact, want to fall), the surfaces are rubberized. Softens the landing for kids when they fall but older adults often trip on these surfaces).
Methods effective for kids and adults often exact opposite.
Good points..its those hidden interactions that we don’t know exist until something happens. I find this the most challenging aspect of improving safety or quality…when we fix one thing do we break another? Is a best practice in one place the best practice for a different culture or population (eg. peds and adults like you mention in the playground example). I think the only way to know is to have some kind of checklist for ongoing evaluation post any implementation. I like to think of this like testing a new drug… the drug is administered then the participants record any new symptom that arises. Every symptom isn’t necessarily from the medication but at least its logged for monitoring to see if it becomes significant. Also challenging, is the sustainability of the fix. I just read an article about an anesthesia safety intervention that practically disappeared in only one year.. The natural lifespan of a safety policy: violations and system migration in anaesthesia