Healthcare DIVE June 23, 2025

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From Safety I to Safety II

With the Institute of Medicine’s report, To Err Is Human: Building a Safer Health System, Centers for Medicare & Medicaid Services applied safety lessons gleaned from the aviation industry’s efforts to learn from defects. Under this new methodology, termed Safety I, human performance and errors are sorted into the following classifications:

  • Skill-based — errors made due to inattention, considering one’s experience with an operation
  • Rule-based — errors made from misinterpreting or deviating from standardized procedures
  • Knowledge-based — errors made from lapses in judgement and decision-making

This framework is a helpful way to focus on the errors and how to eliminate them, but there are limitations. Emerging within the...

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