Editorial: Harm-free care or harm-free environments: expanding our definitions and understandings of safety in health care

Abstract

In recent decades there has been no shortage of attention to the hazards and risks of healthcare. The sustained attention to prevent, or at least minimise, harm to patients has seen an international drive for 'cultures of safety' and 'harm-free care'. These approaches place emphasis on reducing harm, rather than individual blame and disciplinary measures for staff (NHS 2014, ACSQH 2015, HQSC 2015), with increased attention to organisational structures, clinical competence, and communication to prevent harm. While concerted effort has been given to reducing patient harm, what remains unclear is the definition of harm, what types of harm are preventable, and the scale of preventable harms. While some harms are clear and easy to identify; the field is growing in complexity, and the concept of harm, and who has the legitimate authority to define harm are becoming increasingly problematised. Is harm merely the absence of actual visible damage or injury? Or are patients able to be harmed in ways and through means we have not yet clearly recognised or articulated?