Over the past 20 years, there has been rapid growth in interventions to improve the safety of people who receive care. These have focused on process and developing interventions to address the risks that people face when they are treated either in the community or in hospital. It is clear that the improvement in safety is evident, though not uniform, and that the challenge is more than one of improving process but more complex. In this chapter, four key areas are covered. The concept of culture and language is the foundation for safety and a change in culture is the first step. This will then include the development of psychological safety and well-being for people who deliver care, and co-production of safety with those who receive care. The social determinants of safety require further delineation and research. Finally, harnessing the potential of the new technologies and artifical intelligence will be the next step in developing as harm free care as is possible. Redesign of healthcare delivery is essential.
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