How one simple question changed the way I look at risks, mistakes and patient safety.

One of the biggest lessons in my quality improvement journey has been learning not to wait for something to go wrong before we act. I used to think of quality improvement mainly as fixing problems that had already happened. But with time, I realised that some of the most important opportunities to improve are found before harm occurs.

That is where my QI quote was born:

Ask what could go wrong, learn before harm occurs and improve before failure becomes the lesson.

I call it the power of negative manifestation. Not because I expect bad things to happen, but because I have learned to deliberately imagine what could go wrong. When reviewing a process, I now ask myself and the team: What if this step is missed? What if someone misunderstands this? What if the information is not available when it is needed? What could happen to the patient? Those questions can sometimes feel uncomfortable. But they open conversations that might otherwise never happen. I have learned that a process can appear to be working simply because a committed staff member is constantly compensating for a gap, or because we have been fortunate enough not to experience harm. A near miss, a documentation gap or a process weakness can therefore be a gift a chance to learn without a patient paying the price. This changed the way I approach audits and QI. I no longer only ask, “What happened?” I also ask, “What could happen?” For me, that is the heart of patient safety: creating the courage to look at our systems honestly, identify the risks early, and make improvements while we still have the opportunity. I have come to believe that the best QI story is not always the one where we solved a big problem after harm occurred.

Sometimes, it is the story of the harm that never happened because someone asked the right question in time.