TY - JOUR T1 - The systems approach at the sharp end JF - Future Healthcare Journal JO - Future Healthc J SP - 176 LP - 180 DO - 10.7861/futurehosp.5-3-176 VL - 5 IS - 3 AU - Stephen Richard Harrold Cross Y1 - 2018/10/01 UR - http://www.rcpjournals.org/content/5/3/176.abstract N2 - A systems-based approach to patient safety has been widely accepted and advocated. Despite this, and a renewed ­emphasis on organisational learning in improving the safety of patients, many patients still suffer unintended harm during their care. This paper reviews the central theoretical themes of a systems-based approach and raises four key questions ­relating for clinicians working at the ‘sharp end’: how can ­clinical teams best apply a systems approach to patient safety, how can patient safety move from a focus on past harm to a proactive approach, how can we avoid a corrosive culture of blame, and what should our response at the sharp end be to seemingly unsolvable problems? ER -