Strong patient safety systems are a core part of effective clinical governance.
The NSW Health Safety System Model supports implementation of the National Model Clinical Governance Framework, the National Safety and Quality Health Service (NSQHS) Standards, and the Clinical Governance in NSW Policy (PD2025_032).
The model provides a practical framework for strengthening clinical safety systems across NSW Health. It outlines the organisational capabilities needed to identify and respond to risks, learn from experience and support continuous improvement.
Six elements of the model
The model is built on six interconnected elements:
Embedding safety strategically
Accountable leadership and culture
Safety improvement capability
Safety intelligence
Safety governance
Safety improvement
These elements work together to support health services create reliable and resilient systems of care and strengthen clinical governance.
A mature safety system requires both:
depth: where governance, systems, processes, data and capability are well developed, and
breadth: where leaders, managers, clinicians and staff understand their role in the safety system and apply it in daily practice.
Health services may be at different stages of maturity. The model can help assess current capability, identify areas for development and strengthen patient safety systems over time.
Putting the model into practice
The six elements are interconnected and should be considered together. Leadership shapes culture, governance supports oversight and accountability, safety intelligence informs decision-making, and improvement activities generate new insights that guide future action.
As capability develops across all elements, health services can better anticipate risk, respond to emerging issues and improve outcomes for patients, carers and staff.
A reliable and resilient safety system does not happen by chance. As a leader, you need to make safety a strategic priority and embed it in how your health service plans, makes decisions and allocates resources.
Reliable systems consistently deliver safe, high-quality care. Resilient systems can anticipate, adapt to and recover from unexpected events while maintaining safe care. Together, they form the foundation of a mature safety system.
To support this, the policy requires health services to demonstrate leadership commitment through:
an annual attestation statement from the board chair and chief executive
clinical governance as a standing board agenda item
How are we embedding safety in our strategic planning and decision-making?
How do we know our safety priorities align with our greatest risks?
How are our board and executive team demonstrating visible leadership for safety and quality?
Accountable leadership and culture
Create a culture where everyone understands their role in keeping patients safe and feels responsible for acting on safety concerns.
In mature safety systems, people don’t wait to be held accountable. Leaders model the behaviours they expect, teams work towards shared safety goals, and staff feel safe to speak up, learn and improve.
The policy requires health services to ensure staff understand their responsibilities for patient safety, quality improvement and human experience, and have the capability to carry them out.
How do we know staff understand their safety responsibilities?
Do staff feel safe to raise concerns and report mistakes?
How do we demonstrate openness with patients and families when things go wrong?
Safety improvement capability
Build the skills, knowledge and leadership to improve safety across your health service.
Safety improvement is not the responsibility of a small number of specialists. Every staff member should have the skills and support they need to identify risks, test improvements and learn from experience.
The policy requires health services to provide ongoing safety and quality improvement capability development tailored to staff roles.
Do we have enough safety improvement expertise across our health service?
How are we developing future leaders in safety and quality?
How do we share and spread successful improvements?
Safety intelligence
Use data and insights to understand safety performance, identify risks, and determine whether changes are working.
Safety intelligence combines information from incidents, complaints, audits, patient experience measures, outcome measures and other sources. Together, these insights support proactive action to prevent harm and improve care.
The policy requires health services to maintain a documented safety and quality data surveillance strategy.
Do our leaders and teams have access to timely and meaningful safety information?
How do our safety outcomes compare with similar health services?
Safety governance
Use governance structures to oversee safety, identify risks and ensure learning leads to action across your health service.
Effective safety governance allows leaders to understand what is happening across the care continuum and respond to emerging risks. It connects information, accountability and decision-making so that lessons learned in one area improve care across the whole health service.
The policy requires health services to maintain a clinical governance framework that supports:
patient safety
quality improvement
human experience
Aboriginal shared decision-making
The framework should be supported by clear accountability, committee structures, escalation pathways and communication channels.
How do we know we are meeting the Clinical Governance Standard every day?
How do we collectively identify, escalate and respond to safety risks?
How do we know lessons from incidents, near misses and complaints lead to meaningful change?
Safety improvement
Turn insights into action by identifying priorities, implementing improvements and monitoring results.
Use safety intelligence data to identify risks, understand where improvement is needed and track whether interventions are working. Focus on changes that improve systems, practices and behaviours, and embed successful approaches across the health service. Sustainable improvement requires strong leadership, skilled staff, meaningful data and a culture that supports learning.