Systems Safety in Health Care - SSiHC

Our mission

Our research focuses on understanding safety in healthcare. Healthcare is a complex sociotechnical system and the research field mirrors that. Our projects range from the field of cognitive systems engineering to managing large datasets in order to build better safety information systems. We aim at doing clinical safety research with a high focus on defining safe work practices that can be implemented into everyday practice. Most of our projects are collaborative research with the clinical settings and with organisations such as SLL, LÖF or SKL. Knowledge transfer is an important part of our mission. We give courses and lectures on patient safety. Several of our group are working as embedded researchers in healthcare organisations or sit in expert committees.

Four areas of research:

  1. Cognitive work studies In these we aim to map and understand how everyday work gets done by individuals and teams of clinicians and managers. The aim of these studies is to understand clinical cognition and work and which risks and challenges are present when taking care of patients and patient flows. These studies are done in collaboration with KTH and will take place in simulated and real situations.
  2. Safety information systems These studies aim at developing the safety information system available in healthcare by developing and testing validated methods for gathering, analysing and feeding safety information back to decision makers.
  3. Improving safety Our third field is action research oriented projects where researchers support implementation and evaluation of new work practices aiming at improving safety in different health care settings.
  4. Safety culture in health care We aim at understanding how measurement of safety culture supports system safety in healthcare. We also explore successful ways of working with and improving a safe and just culture in healthcare.

Team Members:

Kiku Pukk Härenstam

Team leader, MD, PhD

Mirjam Ekstedt

Team leader, RN, Assistant professor

Magna Andreen Sachs

Senior Lecturer

Maria Unbeck

RN,PhD Post doc

Pelle Gustafsson

MD Assistant professor,Chief medical officer

Mats Hedsköld

RN Doctoral student

Karolina Peltomaa

RN Doctoral student

Anna Dahlgren



CAMST barn

Sebastiaan Meijer Gaming and simulations lab, Transport and logistics KTH


Maria Unbeck, Synnöve Lindemalm, Per Nydert, Britt-Marie Ygge, Urban Nylén, Carina Berglund and Karin Pukk Härenstam Validation of triggers and development of a pediatric trigger tool to identify adverse events BMC Health Services Research 2014, 14:655 doi:10.1186/s12913-014-0655-5

Mats Hedsköld, Karin Pukk-Härenstam, Elisabeth Berg, Marion Lindh, Michael Soop, John Øvretveit and Magna Andreen Sachs  Psychometric properties of the AHRQ hospital survey on patient safety applied on a large Swedish health care sample BMC Health Services Research 2013, 13:332  doi:10.1186/1472-6963-13-332

Kristina Schildmeijer, Maria Unbeck, Olav Muren, Joep Perk, Karin Pukk-Härenstam and Lena Nilsson Retrospective record review in proactive patient safety work - identification of no-harm incidents. Accepterad för publikation juni 2013 BMC Health Services Research

Unbeck M, Schildmeijer K, Henriksson P, Jürgensen U, Muren O, Nilsson L, Pukk Härenstam K. Is detection of adverse events affected by record review methodology? An evaluation of the Harvard Medical Practice Study method and the Global Trigger Tool. Patient Saf Surg. 2013 Apr 15;7(1):10. doi: 10.1186/1754-9493-7-10.

Unbeck M, Sterner E, Elg M, Fossum B, Thor J, Pukk Härenstam K. Design, application and impact of quality improvement ‘theme months’ in orthopaedic nursing: a mixed method case study on pressure ulcer prevention. Int J Nurs Stud. 2013 Apr;50(4):527-35.

Petter Westfelt, Mats Hedsköld, Karin Pukk Härenstam, Rose-Marie Svensson, Carl-Johan Wallin ”Effektiv träning I samarbete på den egna akutmottagningen- med patientsimulering och utbildade tränare. ”Läkartidningen nr 10 2010 Vol. 107, sid. 685-689

Maria Unbeck, Nils Dalén, Olav Muren, Ulf Lillkrona, Karin Pukk Härenstam ” Healthcare processes must be improved to reduce the occurrence of orthopaedic adverse events.  Scand Journal of Caring science, 2009

Pukk Härenstam K, Elg M, Svensson C, Ovretveit J, Brommels M "Patient safety as perceived by Swedish leaders" International Journal of Health Care Quality Assurance Vol 22, no 2, 2009 pp.168-182

Pukk Härenstam K, Ask J, Brommels M, Thor J, Penaloza RV, Gaffney FA “Analysis of 23,364 patient-generated, physician reviewed malpractice claims from a non-tort, blame-free, national patient insurance system: Lessons learned from Sweden” Journal of Qual Saf Health Care. 2008 Aug;17(4):259-63.

Thor J, Lundberg J, Ask J, Olsson J, Carli C, Härenstam KP, Brommels M.”Application of statistical process control in healthcare improvement: systematic review.”Qual Saf Health Care. 2007 Oct;16(5):387-99. Review.

Pukk K, Aron DC.”The DNA damage response and patient safety: engaging our molecular biology-oriented colleagues”.Int J Qual Health Care. 2005 Aug;17(4):363-7.

Pukk K, Lundberg J, Gaffney A, Penaloza RV, Olsson J. “Do health care managers know the comparative quality of their care?” Quality Management in  Health Care. 2003 Oct-Dec;12(4):232-9.

Pukk K, Lundberg J, Penaloza RV, Brommels M, Gaffney FA.” Do women simply complain more? National patient injury claims data show gender and age differences” Qual Manag Health Care. 2003 Oct-Dec;12(4):225-31.


AFA, Forte, Vinnvård

Health Care Service and Management