PATIENT SAFETY AND QUALITY IMPROVEMENT IN CLINICAL PRACTICE

Abstract

The evolution of the concepts of patient safety and quality improvement in healthcare reflects a fundamental paradigm shift, transforming from a historical approach that emphasized individual error (individual blame) toward an integrated systemic analysis paradigm (system-based approach) (Anders, 2025; Mohamed Badran et al., 2026; Singh et al., 2026). Historically, the evaluation of the quality of medical care was rooted in the Donabedian framework (1966), which conceptualized quality through three main components: structure (structure), process (process), and outcome (outcome) (Anders, 2025). Within this framework, patient safety was initially treated as a passive part of the process element. However, the understanding of medical incidents underwent a conceptual leap through the formulation of the Swiss-Cheese Model by James Reason (1990), which emphasized that medical accidents rarely occur as a result of a single individual failure (Anders, 2025; Guntschnig et al., 2025). Instead, incidents arise when gaps in latent failures (latent conditions) at the organizational, technological, and policy levels combine with active failures (active failures) at the frontline of care (Balague-Viladrich et al., 2026; Mohamed Badran et al., 2026). Entering the modern era, patient safety has transformed from merely reactive compliance with standards into a primary foundation underlying all dimensions of healthcare quality improvement.