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Cost-Benefit Decisions in Safety Assessments

Cost-benefit decisions in safety assessments in safety-critical industries: lessons for healthcare

Funded by the Health Foundation Insight research programme (2013 - 2014)


This project will identify and summarise the main arguments, accumulated knowledge and best practices from safety-critical industries over the decades in order to inform with these lessons the current discussion around cost and safety in healthcare.

Aims and Objectives:

To describe how cost-benefit decisions in safety assessments are made in safety-critical industries, and to identify lessons for healthcare.

The study objectives are:

  1. to identify and to describe regulatory requirements, guidelines and industry best practices that inform how cost-benefit decisions are made in safety assessment in safety critical industries
  2. to describe perceptions of stakeholders in the different industries on how such decisions are made in practice
  3. to derive possible lessons for healthcare.

The safety-critical industries that will be considered in this project are aviation, defence, nuclear, petrochemical and transportation.

Study Design

The project employs three instruments in order to achieve the respective objectives:

  1. Rapid, narrative literature reviews will be conducted for each industry by experts in the respective industry
  2. Semi-structured interviews will be conducted with participants from each industry (approx. 5 per industry), and will be analysed using thematic analysis
  3. A workshop will be held with healthcare stakeholders followed up by a Delphi process to stimulate discussion and to identify lessons that could be applicable to healthcare. The final report will reflect on applicability and limitations of these lessons in a health context.

A project report will become available in the first half of 2015.


SUJAN, M. A., HABLI, I., KELLY, T. P., GÜHNEMANN, A., POZZI, S. & JOHNSON, C. W. 2017. How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process. Reliability Engineering & System Safety, 161, 1-11.

Project team

Mark Sujan (PI)

Matthew Cooke

Adelard: Prof Robin Bloomfield, Dr Nick Chozos

Deep Blue: Alberto Pasquini, Dr Simone Pozzi

Human Reliability: Dr David Embrey, Jamie Henderson

University of York: Dr Tim Kelly

University of Leeds: Dr John Nellthorp

University of Glasgow: Prof Chris Johnson

Karolinska Institute: Dr John Øvretveit