A Culture of Safety in Focus

At the 2025 annual meeting of Akureyri Hospital, Björn Gunnarsson, specialist physician and Clinical Director of Quality and Safety, gave a presentation on developments in quality and patient safety. He described the journey that healthcare systems around the world have undertaken in recent decades and emphasized that safety must not only be a goal, but a deeply rooted part of the culture and daily practice.

Lessons from Aviation and Human Error
At the beginning of his talk, Björn recalled the deadliest aviation accident in history, which occurred in Tenerife in 1977. A total of 583 people lost their lives when a KLM aircraft took off without clearance and collided with another plane on the runway. The tragedy was caused by a miscommunication between the control tower and the flight crew. Two people in the cockpit had doubts but remained silent – likely because, as Björn put it, "The captain must be right."

Björn pointed out that this accident marked the beginning of systematic improvements in aviation safety culture. A similar shift is now taking place in healthcare, although the pace of change has been slower. In the United States, it is estimated that medical errors contribute to as many as 250,000 deaths each year. “That’s equivalent to one PanAm jumbo jet crashing every day,” he said, adding that such a reality is unacceptable in one of the world’s most advanced healthcare systems.

From Simple Solutions to Deeper Understanding
Björn outlined a three-stage development of safety work: beginning with superficial simplification relying on checklists and standard procedures; progressing to a complex and ambiguous environment where multiple factors can influence outcomes; and finally reaching a level of deep simplicity – where real success is built on experience, research, data-driven analysis, and culture.

He stated, “We have done many things right and achieved progress – but we haven’t come far enough. We don’t always know which improvements actually lead to real results. We need more data, clearer metrics, and a deeper culture of safety.”

Communication and Participation Are Key
His presentation highlighted that communication and trust within teams are critical. Mistakes often stem from inadequate information sharing and misunderstanding. Björn stressed the need to improve information flow, strengthen handover responsibility, and engage patients and their families. He referred to “Martha’s Rule,” a newly introduced regulation in the UK that allows patients and their families to call in a second medical team if they are concerned about deterioration.

“A culture of safety is not the path to the goal – it is the goal.”
He concluded by emphasizing the importance of collaboration and shared responsibility. “There will always be human error – but we can potentially prevent half or more of the errors that lead to serious consequences,” he said. With a safety culture built on knowledge, experience, communication, and active user participation, the goal is to ensure safety – not merely as a process, but as a mindset.