Combination of the UK model and the outcome engineering model

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Allen Frankel and Michael Leonard propose a combination of the two models, with some simple questions to help investigators walk through the possibilities:

Was the individual knowingly impaired? Did the individual consciously decide to engage in an unsafe act? Did the caregiver make a mistake that individuals of similar training would be likely to make under the same circumstances (substitution test)? And does the individual have a history of unsafe acts? This short list of questions provides a clear model of accountability and also tells providers “what the rules are,” so they can feel safe to speak up, facilitating ongoing education and improvement.


1. Leonard MW, Frankel A. The path to safe and reliable healthcare. Patient Educ Couns. 2010;80(3):288–92. doi:10.1016/j.pec.2010.07.001.