Le sujet est traité en 4 parapgraphes :

1. La désillusion de l’analyse des causes profondes (RCA*) *Root Cause Analysis

2. Les insuffisances de l’exploitation des EIAS

3. Les solutions possibles : arrêter – tout changer – perfectionner

4. Le positionnement de Gynerisq

Certaines références bibliographiques citées sont disponibles sur le site 

• DW Bates & H Singh. Two Decades Since To Err Is Human: An Assessment Of Progress And Emerging Priorities In Patient Safety. Health Af, 2018
• J Martin-Delgado et al. How Much of Root Cause Analysis Translates into Improved Patient Safety: A Systematic Review. Med Princ Pract 2020
• LT. Johansen et al. Adverse events reporting by obstetric units in Norway as part of their quality assurance and patient safety work: an analysis of practice. BMC Health Serv Res 2021
• KG Shojania et al. Identifying adverse events: reflections on an imperfect gold standard after 20 years of patient safety research. BMJ Qual Saf 2020
• HAS _ Guide méthodologique pour l’analyse des EIAS 2021
• E Hollnagel, RL Wears, J Braithwaite. From Safety I to Safety II : a white paper. 2015
• B Hüner et al. Preventable Adverse Events in Obstetrics—Systemic Assessment of Their Incidence and Linked Risk Factors. Healthcare 2022
• S Isaksson et al. Monitoring Preventable Adverse Events and Near Misses: Number and Type Identified Differ Depending on Method Used. J Patient Saf, 2022