💬 Viewpoint by Victor Hassid, MD, MBA, and Haytham Kaafarani, MD, MPH: Administrative delays and access failures introduce patient safety risks but are rarely treated as safety events in health systems.
More than 2 decades after To Err Is Human,1 health care has made substantial progress in defining, measuring, and mitigating clinical harm—by adopting high-reliability principles, implementing safety reporting systems, standardizing protocols, and embedding accountability instead of blame into clinical workflows. Yet access to care—despite being the gateway to all downstream clinical activity—remains largely outside this safety framework.
Delays in access are often discussed as throughput problems, capacity constraints, or scheduling inefficiencies. Rarely are they framed as patient safety issues. This distinction is consequential. When access failures are viewed as operational challenges, they are addressed as desk tasks—episodically and locally. When they are viewed as safety failures, they require immediate systematic analysis, leadership attention, and organizational accountability.
High-reliability organization principles provide a useful lens for reframing patient access to care as safety, even when accountability spans multiple stakeholders rather than a single organization.2 The preoccupation of high-reliability organization with failure requires attention to near misses, not just catastrophic outcomes. Reluctance to simplify acknowledges that access pathways are complex sociotechnical systems, not simplistic linear workflows. Sensitivity to operations requires understanding how delays in record retrieval, insurance authorization, or appointment scheduling propagate through the system and translate into patient harm. Deference to expertise elevates the voices of frontline access staff who understand when and where systems break down. Commitment to resilience requires learning from access failures and rapidly redesigning processes to prevent recurrence.
