"Going solid": a model of system dynamics and consequences for patient safety.
Health care systems continue to evolve with greater complexity and attention to system-based improvement efforts. This article explores ongoing shifts in care delivery operations and the potential they create for accidents. Discussion includes both written and graphic descriptions of a dynamic safety model, explanation of "tightly coupled" systems, and the associated reactions and consequences of providing care in these types of systems. The authors conclude that improvements in organizational efficiency have led to "going solid," which poses new challenges and barriers to patient safety.