A response to ‘Use of carbon dioxide extubation’

a concomitant of all human performance. Such a ‘systems approach’ is the opposite of the person approach and this change in perspective seems to be a long time in coming in anaesthesia. To ensure such system redesign is appropriate and targets problem areas, it should be based on good quality, anonymous incident data, which is the best sustainable source of information about actual system performance. Critically, effective system redesign requires the focus of safety initiatives to be widened from the individual clinician to the larger technological system within which the clinician acts – and the persistence of the person approach in medicine frequently prevents this. Until such a wider focus is adopted, most faults embedded throughout medical systems will remain out of sight and unresolved. The systems approach does not detract from the importance of the anaesthetist’s clinical expertise, nor should it lead to inappropriate system redesign which hampers the anaesthetist. Good system redesign should provide a more robustly error-tolerant working environment, while simultaneously increasing safety and facilitating performance.