- To err is human. The first concept is to consider that the error is a phenomenon inherent in human nature and occurs even in the most perfect systems. That is, it is necessary to assume that, regardless of training and care of people, mistakes can happen and invariably occur in any human process, including the complex sanitario.

Given that you can not change the human condition, to improve the safety of care, the realistic then it will change the conditions under which people work. This is necessary to create health insurance systems that are resistant to human error, that is, to help prevent errors, to identify and / or minimize their consequence. This concept is one that seeks to highlight the title of the first report of the Institute of Medicine: To err is human. Building a safer health system.

- Safety does not reside in individuals, but is a characteristic of a system as a whole. Errors should be analyzed from the perspective that occur because there are failures in system components (system approach) and not by incompetence or failure of individuals (person approach), as has been the traditional approach to ahore..

When accidents are analyzed from the perspective of systems analysis is usually to check that even the simplest not due to a single failure, but almost always the result of the combination of multiple failures or errors, among which are distinguished on the one hand, latent failures or defects present in the system itself linked to deficiencies in the organization, working procedures, technical resources, labor conditions, etc. and, secondly, active faults or errors of the professionals who work involved in that system failures. Consequently, punish or eliminate the individual “guilty” of the error will not change the latent defects of the system and it is likely that the same mistake again happen again. Therefore, it is said that when an accident should not be trying to find who was involved in it, but what matters is analyzed to identify how and why it has.

- To improve the security of the systems must learn from mistakes that occur. Only then can identify the root causes and develop strategies to prevent repitan. This requires creating a professional culture is not punitive discard the idea of guilt and promotes communication and error analysis.

In the health field, this is a huge cultural change, since traditionally the medical and society itself have assumed that health professionals are “perfect” and work without error, that is, that mistakes are unacceptable or are associated with negligence. Therefore, in the field of medicine has always tended to cover up errors for fear of professional prestige and possible sanciones. In fact, at present, unlike what happens in other industries, health care institutions often do not have protocols for action known to all professionals who specify what to do and how to handle errors when they occur or have established channels to communicate and constructively analyze information about the errors, nor, more importantly, have structures to find solutions and make improvements to prevent similar mistakes happening again.

Moreover, there are other barriers imposed by the legal systems that pose perhaps the greatest obstacle to the development of communication programs and analysis errors. In this sense it is necessary to change the legal rules so as to ensure the protection and confidentiality of information in order to avoid the logical fears of being involved in professional malpractice lawsuits. This adaptation of legal rules is a crucial step to encourage error reporting.

- The general culture, the flow of decisions and procedures of an organization play a role in security. The study of organizations called “high reliability”, ie those working in high-risk conditions and yet have a low frequency of accidents, has made us aware that possess specific characteristics that explain its low accident rate. These features are those that seek to introduce in such areas.

Thus, these organizations show a constant concern for safety which considered a corporate value. Do not rely on its success, but systematically review and monitor their organization and working procedures. Do not wait for an accident, but that anticipate and investigate all circumstances and changes that may compromise their seguridad. They rely on the standardization of equipment and procedures to reduce variability. Educate their members in safe practices, the form in teamwork and trained to take less and observe. They have flexible decision structures based on the experience of professionals working at the forefront, especially in situations of crisis. Have non-punitive systems of communication and information flow failures and incidents, and demonstrate the value of this information and use it to make changes constructive.