Safety-II and safety ergonomics

The starting point for Safety-II is that patient safety is increased by focusing on the adaptability and resilience of professionals in the context in which they work.

Adaptability and resilience

In Safety-II, safety is examined from a positive perspective, in its PRESENCE of safety, rather than investigating only what is not going well, or ABSENCE of safety. That which goes well every day is made visible and improved; lessons are learned from this and this is further supported and disseminated.

About this programme

At the end of 2018, the programme 'Time for connection' was drawn up by The Dutch association of Medical Specialists (FMS), The Dutch Association of Hospitals (NVZ), The Dutch Federation of University Hospitals (NFU), the Dutch Patient Federation and the The Dutch Nurses Association (V&VN). In the programme 'Time for connection', one of the pillars focuses on the subject of Safety-II and safety ergonomics (pillar 3)The Ministry of Health (VWS) has asked ZonMw to draw up a research programme for this pillar: the Safety-II and Safety Ergonomics programme.


The aim of the Safety-II and safety ergonomics programme is to investigate whether the principles of Safety-II also work in the practice of hospital care in the Netherlands and whether they also contribute to safer care for patients. It is a learning program as part of the overall program 'Time for connection', which will initiate a movement that will further embed the approach in practice.

5 phases

The programme runs until 2024 and includes 5 phases:

  1. We had a ‘knowledge synthesis’ drawn up that provides focus and prioritisation (January 2020).
  2. Subsequently, a subsidy round with learning processes took place in the form of (action) research (2020/2021). These studies started in 2021.
  3. In February 2022 a second subsidy round started.
  4. In January 2023 the first round was evaluated together with the project leaders.
  5. After evaluation of the results of the 2nd subsidy round, insight will be gained into the effective elements of Safety-II. This, we hope, will bring about a movement that spreads knowledge.
5 phases of the Safety-II programme

11 funded studies on Safety-II in first subsidy round

  • Freedom in a frame: freedom of action for craftsmanship
  • Successful discharge: action research on timely, correct, compact and complete discharge messages when transferring patients from hospital to elsewhere
  • Learning from correct diagnoses
  • Development and evaluation of the Resilience Analysis Grid (RAG-NL) in Dutch hospitals
  • With VERVE: Nurses in the lead for quality and patient safety
  • Room for resilience: accountability differently in the relationship between 'work as imagined' (WAI) and 'work as done' (WAD)
  • Safe transfer NICU
  • Safety-II in ICU: positive and reflective learning and improvement
  • Video reflection of acute interventions in daily care: framework and success factors for implementation
  • Visiting with the patient, learning from practice variation: an exploratory action study into the effective elements of Safety-II
  • What goes right? A resilient, learning and open safety system for nursing use of medical technologies around the patient's bedside

12 funded studies on Safety-II in second subsidy round

  • Learning from daily practice, action research towards developing mindful habits in healthcare visits (Radboudumc)
  • Safety-II education focussed on anticoagulation in the master medicine (Erasmus MC)
  • Study-buddy: The better you know me, the more resilient you will be. Design-based and participatory action research to study multidisciplinary perspective taking and learning in reciprocity by patients and healthcare professionals to strengthen resilience and personal leadership in a demanding healthcare setting. (Radboudumc)
  • Resilience and self-regulation in the operation room: the key to excellence? (LUMC)
  • From reflection towards anticipated improvement: patient safety at a semi-acute admission to the hospital (Gelre Ziekenhuizen)
  • Safer care of infusion pumps in daily practice. (VieCuri Medisch Centrum voor Noord-Limburg)
  • Careful and safe transition of IC-patients to nursing wards. Learning and improving based on ‘work as done’ and success stories of patients, friends or relatives and professionals. (Radboudumc)
  • Finding the right diagnosis together: team communication at the first aid (HagaZiekenhuis)
  • Safe landing (UMCU)
  • Room for resilience II: securing Safety-II in teams and hospitals long term (Erasmus School of Health Policy and Management)
  • Transcending learning of calamities towards improvements in daily practice – The Dutch Resilience Analysis Grid as a Safety-II intervention tool (Nivel)
  • Learning from successful discharge. Action research towards implementing Safety-II lessons and analysis in a different setting (UMCU)

Programme committee

A programme committee advises ZonMw on the further elaboration of the main points of the programme, the content of the call for grants, the selection of grant applications and monitoring of the project progress. Various expertise is represented in the committee. The members function in a personal capacity.


Dr L. (Loes) Pijnenborg


S. (Sander) Hermsen MSc
Prof. I.P. (Ian) Leistikow
Dr M.J.A. (Marjolein) Tasche 
Dr B. (Bram) Verhees
P. (Peter) Vink, MSc
Dr M.S. (Marit) de Vos
Prof. T. (Theo) van Achterberg
Dr I. (Irene) Grossmann


G.B. (Georgette) Mentink-Kleis, Ministry of Health (VWS)


S.M. (Simone) Schellekens MSc




€ 4.000.000
Duration: 100%
Duration: 100 %
Sequel to program:


Simone Schellekens

Senior Programme Manager
safety [at]

Bobby Otto

Programme Secretary
safety [at]

Milly de Recht

Cluster Assistent
safety [at]