ArticleArchives of disease in childhood2021
First do no harm: practitioners' ability to 'diagnose' system weaknesses and improve safety is a critical initial step in improving care quality.
Article in Archives of disease in childhood, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed.
- Pathways of emergency care for severely ill children in Nigerian and Ugandan hospitals: A process mapping study.PLoS medicine · 2026Article
- Systems analysis of clinical incidents: development of a new edition of the London Protocol.BMJ quality & safety · 2025Review
- Barriers and enablers of quality high-acuity neonatal care in sub-Saharan Africa: protocol for a synthesis of qualitative evidence.BMJ open · 2024Article
- Receive, Sustain, and Flow: A simple heuristic for facilitating the identification and treatment of critically ill patients during their hospital journeys.Journal of global health · 2023Article
- Hospital care for critical illness in low-resource settings: lessons learned during the COVID-19 pandemic.BMJ global health · 2023Review
- Article
- Improving facility-based care: eliciting tacit knowledge to advance intervention design.BMJ global health · 2022Article
- Article
- Enhancing psychological safety in mental health services.International journal of mental health systems · 2021Review
- How to do no harm: empowering local leaders to make care safer in low-resource settings.Archives of disease in childhood · 2021Article
- Employing learning health system principles to advance research on severe neonatal and paediatric illness in Kenya.BMJ global health · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
Healthcare systems across the world and especially those in low-resource settings (LRS) are under pressure and one of the first priorities must be to prevent any harm done while trying to deliver care. Health care workers, especially department leaders, need the diagnostic abilities to identify local safety concerns and design actions that benefit their patients. We draw on concepts from the safety sciences that are less well-known than mainstream quality improvement techniques in LRS. We use these to illustrate how to analyse the complex interactions between resources and tools, the organisation of tasks and the norms that may govern behaviours, together with the strengths and vulnerabilities of systems. All interact to influence care and outcomes. To employ these techniques leaders will need to focus on the best attainable standards of care, build trust and shift away from the blame culture that undermines improvement. Health worker education should include development of the technical and relational skills needed to perform these system diagnostic roles. Some safety challenges need leadership from professional associations to provide important resources, peer support and mentorship to sustain safety work.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.