1. System Barriers To Achieve Safe Health Care Presented by Mr. Amrth Ganapathy A.P MBA (HHC), Symbiosis Institute of Health Science, Pune.

2. SAFE HEALTH CARE IMPROVING PATIENT CARE W H Y ? PATIENT SAFETY AND; THE RELIABILITY OF HEALTH CARE SYSTEMS

3. Barriers Preventing a Safe Industrial System: The discretion of workers, The worker autonomy Craftsmanship mindset Biased Arbitration Complexity of Professional Rules and Regulations.

4. Acceptance of Limitations on Maximum Performance Regulations that limit the level of risk allowed. level dictated in situations in which high levels of production and performance. "attain a specified high level of production, no matter what it takes"—the system is very unsafe.

5. The discretion of workers, The worker autonomy Craftsmanship mindset Biased Arbitration Complexity of Professional Rules and Regulations.

6. Abandonment of Professional Autonomy Restriction of the autonomy of health care professionals. Educating health care professionals reduces the autonomy of health care professionals. Systemic thinking and anticipation of the consequences of processes across departments remains as major challenges.

7. The discretion of workers, The worker autonomy Craftsmanship mindset Biased Arbitration Complexity of Professional Rules and Regulations.

8. Craftsman To An Equivalent Actor To achieve the next increase in safety levels, health care professionals must face a very difficult transition:  abandoning their status and self-image as craftsmen and instead adopting a position that values equivalence among their ranks.

9. The discretion of workers, Biased Arbitration Complexity of Professional Rules and Regulations.

10. System-Level Arbitration to Optimize Safety Strategies The increase in pressure from medical malpractice liability and media scrutiny has created a need for system-level arbitration. The safer a system is, the more likely it is that society will seek to hold people accountable or seek legal recourse when injuries occur.

11. Complexity of Professional Rules and Regulations.

12. Need To Simplify Professional Rules and Regulations Accumulation of layers intended to improve safety but, make system ◦ overly complex, ◦ burdensome, and ◦ overprotected. When risks to patients become less observable, the best move is to ◦ simplify the system, ◦ eliminate nonproductive regulations, and ◦ give clinicians more latitude in decision making.

13. Finally, Health care must overcome 3 unique problems:  A wide range of risk among medical specialties,  Difficulty in defining medical error, and  Various structural constraints.

15. Conclusion The industry, yet to traverse fully the barriers to safety. Quality improvement programs, cannot overcome these barriers. Mastering the barriers will be a challenge and will require accepting limitations. Reduction of errors may also constrain the professional latitude that health care providers have.

16. Thank You