In recent years, there has been increased interest in involving the public to enhance the quality of care and improve the “patient experience” with a view to increasing their trust in the health system.^1–3 Beyond giving their feedback on in-hospital experiences, several articles and reviews have considered how patients could play an active participant role in the safety of their own care processes.^3–7 Examples of this role include researchers asking patients to verify with staff that they have washed their hands, or patients complying with instructions to mark the “non-surgical site” before surgery.^6–8

However, based on experience of safety in other industries, it could be argued that relying on this type of patient participation should not be a solution worthy of long-term investment at the governmental level, but should rather be an unexpected source of help in its sporadic occurrence.

Although this issue has been discussed previously in health policy literature,^9,10 there has as yet been no application of the knowledge of safety engineering from high-reliability industries to this issue.

For predominantly human-based systems in such industries, the field of “human factors” uses human reliability analysis (HRA) techniques such as HEART or THERP to define the attributes of a task, system or environment that would make it vulnerable to human error.

The HEART technique¹¹ lists error-producing conditions (EPCs) such as the “familiarity of the task and the user’s experience with it”, “levels of supervision” and the “complexity of the task”.

The THERP technique¹² identifies performance-shaping factors (PSFs) such as quality of the physical environment (noise, temperature and cleanliness); any presence of written procedures, team structure and communication. THERP also uses a large selection of “stressor PSFs” which may be psychological (presence of distractions) or physiological (fatigue, pain, discomfort, suffering from …