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SSA Toolkit

Introduction to SSA


Introduction to SSA

Introduction to SSA

System Safety Assessment (SSA) is a method to help healthcare staff think about ‘what could go wrong’ in a healthcare system. A system could be anything from a care pathway to a project plan for a service improvement, to a new ward or even the movement of a service from acute care to the community. Rather than waiting for things to go wrong and suffering the consequences, SSA is a process for proactively thinking about and addressing potential problems, so they can be prevented up front.

On this page:

Photo of people conducting an SSA

Conducting an SSA *

What is SSA?

SSA is a proactive method to help think about ‘what could go wrong’ in a system. At the core of SSA is a standard process for managing risks. The principles will be familiar to many people in the NHS, but the systematic and proactive way in which it is done may be less so.

The types of risk being assessed may also be different. Current risk assessments in the NHS often focus only on ‘health and safety’ risks, such as the risk of slips, trips and falls. SSA, however, can focus on any type of risk, including clinical, project management, financial and organisational risks.

Each stage in the SSA process addresses a key question. Examine addresses What is going on? Assess looks at What could go wrong? Improve looks at What can we do about it? And Manage focuses on What should we do next in the SSA?
SSA is a method to help think about what could go wrong in a system. See the Overview page for more details.

Why do an SSA?

Every system presents its own risks to safe and effective operation. Despite the dedication and competence of the staff who plan, operate and manage healthcare systems, the complexity of the system and pressures on performance can often lead to quality problems. Identifying and managing risks up-front before they have caused harm can improve the quality of a service, reduce costs and reduce frustration for staff and patients, who so often have to battle with systems that are not designed as well as they could be. SSA is ultimately a way to help create better healthcare systems, which benefit patients, staff and organisations.

Photo of people examining a healthcare system using SSA

SSA helps to create better healthcare systems, which will benefit patients, staff and organisations *

How does SSA work?

SSA can help to reduce risk and improve quality by getting people together and giving them the ‘head-space’ to think through potential problems using a systematic process.

The first step to working out ‘what could go wrong’ is to describe the system. This might be in the form of a set of procedures, known risks or incidents, but often involves some process mapping, typically using flow charts or other types of diagram. The description forms the basis for thinking about what could go wrong in a careful and systematic way.

Once it is known what could go wrong it is necessary to think about how likely this is and how bad it would be if it did go wrong - the risks.

If any of these risks are too big, the next step is to consider how to reduce them. The SSA process helps to develop a range of actions, and then to choose the best ones by considering attributes such as their effectiveness, costs and ease of implementation, and how the effectiveness will be measured.

All of this is done in a proactive and systematic way, across the system that is being looked at. It also requires the knowledge of system experts - usually anyone who has had experience of the system or a similar one. More detail about how the SSA works is given in the Guide section of this website.

Photo of people filling in SSA forms as a team

SSA gives people space to think through potential problems together using a systematic pocess *

Who is SSA for?

SSA is intended for use by a team of healthcare staff (usually around 3-8 people), supported by a facilitator who has been trained in the SSA process. For more complex SSAs it can also be helpful to have a team lead or project manager to help run the administrative side. It is crucial that this team has a good range of practical knowledge about the system under investigation, but they do not need any training in SSA.

Conducting an SSA involves some time commitment. The time involved depends very much on the size of the system to be looked at, the level of detail examined and the level of desired comprehensiveness in the assessment. SSAs can take as little as two hours, but more comprehensive SSAs may take several sessions of half a day or so. As facilitators it is important to be flexible and sensitive to the needs of the participants, so that a good balance can be struck between pragmatism and rigour.

Photo of people conducting an SSA

SSA is intended for use by a team of healthcare staff supported by a facilitator *

When should an SSA be conducted?

Ideally SSA should take place early in the design stage of a new healthcare system (or during the development of a change to an existing system), since at this point further changes can be much easier to make. It is also possible to conduct an SSA on an existing system, prior to any further changes. In this case, problems may have already been identified, and SSA can be used to prioritise these, and to consider whether further potential issues might surface.

Photo of a man examining a diagram of a system during an SSA

SSA can be used early in the design phase of a new healthcare system or on an existing system, prior to further changes *

Why use this website?

This website (the SSA Toolkit) provides key information about SSA. It is best used together with face-to-face training, to enable a facilitator to work through the steps in an SSA in detail. However, it can also be used on its own to provide an introduction to SSA. As such, the members of an SSA team may find it useful for gaining an overview of the SSA process.

If you have not been through a face-to-face training process and would be interested in doing so, please contact us at

Screenshot of the SSA Toolkit website

The SSA Toolkit provides key information about SSA