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In preoccupation with failure, nurses and other health care providers are aware that the risk of error is always present. An HRO recognizes that failures can occur and deploys processes to diminish harm. An HRO proactively identifies high risk activities and analyzes all the potential error points in the process. This analysis can be performed as a Failure Modes and Effect Analysis (FMEA), a rigorous process in which a team of clinicians identify and eliminate known and potential failures, errors, or problems before they occur (Hughes, 2008). Failures are prioritized according to the seriousness of the consequences, how frequently they occur, and how easily they can be detected. An FMEA example is provided in Figure 4.2.

FIGURE 4.2 FMEA.

Source: Patti Ludwig‐Beymer.

Preoccupation with failure requires that critical information be communicated across time, across the health care team, and across sites of care. For example, a patient may be seen in the Emergency Department (ED) and require admission to the acute care hospital. Prior to transferring the patient, the ED nurse provides a thorough report to the nurse on the receiving unit.

In preoccupation with failure, nurses report questionable or unsafe practices. They notice and learn from near miss safety events and precursor safety events. These events are viewed as early warnings that something is wrong. Nurses recognize when an error can or has occurred, feel confident in stopping unsafe practices, and assume the responsibility for reporting errors or near misses. The organization then uses the reports to correct unsafe processes through rigorous process improvement activities.