Risk, safety and organisational change in health care

The increased emphasis on risk assessment and management in health care systems has major implications for the overall management and delivery of health care. Concerns with ensuring safety and minimizing harm are driving 'modernization' of health care systems. In this editorial I use recent articles published in Health, Risk and Society to consider the implace of such changes on professional decision-making, especially the pressure to move from decisions grounded in tacit knowledge to those based on knowledge encoded in clinical guidelines or computer-based decision support systems. These articles indicate that the current changes are unlikely to have the desired impact as they tend to disregard the reality of professional decision-making, especially the ways in which professionals need to use tacit knowledge when using decision-support systems and they also fail to recognize that professionals can exploit and use risk and uncertainty to override formal decision-making systems.