More than 25 years after the modern “quality movement” took off, healthcare is still not as safe as we want it to be. Checklists, protocols and investigations have helped, but improvement has slowed while care has become more complex. Medical teams work in settings where conditions often shift rapidly, the margin for error is slim, and success depends as much on coordination and adaptation as on technical skill.
Could team sports offer insights for improving safety?
Safety I and Safety II
Traditionally, safety was seen as the absence of error (“Safety I”). The focus was finding failures and tightening controls. Interventions like central-line bundles and surgical safety checklists brought important improvement but the limits of this approach are now visible in persisting rates of potentially preventable harm.
“Safety II” shifts the focus to how work usually goes right. Doctors and nurses constantly adjust to keep patients safe despite interruptions, competing demands and imperfect systems. In this view, safety is the capacity to succeed under varying conditions.
Sport, where teams must adapt on the fly, may be a useful mirror.
1. Train for variability: the Cleveland Cavaliers.
In 2024–25, the Cleveland Cavaliers adopted a coaching method called the constraints-led approach (CLA). Instead of standard drills, players practise in variable, game-like situations with shifting rules, space and opposition. The aim is to improve pattern-recognition and improvisation.
The team’s performance sharply improved, winning 64 of 82 games (the second-best season in team history), finishing as the top seed in the Eastern Conference, and sweeping the Miami Heat 4-0 in Round 1 of the playoffs.
Healthcare equivalent: simulation and tabletop exercises that deliberately include “friction”, for example unexpected staff shortages, equipment failures or competing emergencies. The goal not to execute the drill but to practice adjusting, coordinating and recovering when things don’t go strictly to plan.
2. Relationships and intelligent risk-taking: Rassie and the Springboks.
In rugby, the world champion Springboks are known for physical dominance and disciplined structure. Under coach Rassie Erasmus, they have combined this with tactical creativity. The brilliant documentary Chasing the Sun shows a team culture built on trust, honesty and shared purpose.
Springbok players describe being able to try new ideas because relationships are strong and blame is not the starting point. Innovation happens without losing the fundamentals.
Captain Siya Kolisi describes this, and credits Rassie: “He’s always honest with us and direct … he keeps us humble … always looking for other ways to make our team better. And our group, we are always willing to try something. We don’t say, ‘That’s not going to work.’” Erasmus says, “Winning the World Cup is nice, but the most beautiful thing is what we have created”, pointing to the importance of organisational culture over trophies alone.
Healthcare equivalent: teams where everyone, from cleaners and porters, to consultants, feels respected and able to question, suggest and contribute. Reliable care depends not only on “standard work” but on relationships that allow teams to adjust safely to the unexpected.
3. Psychological safety for team learning: Ted Lasso
In TV’s popular Ted Lasso, an American coach, takes over an English football club, played with comically steadfast optimism by Jason Sudeikis.
The “Diamond Dogs” scenes show Ted establishing an informal forum in which he, coach Beard, “kit man” Nathan (Nate), and club manager Higgins share their struggles. Ted admits mistakes, offers second chances and credits Nate for a winning play, signalling that good ideas can come from anywhere.
This dramatises what Amy Edmondson calls learning behaviours that underpin psychological safety: candour, curiosity and respect.
Healthcare equivalent: short, regularly convened spaces where staff can raise concerns, share near-misses and reflect on what helped or got in the way of care that day. Small moments of openness accumulate into a stronger safety culture and more reliable everyday work.
From sport to safety science: five takeaways
These observations from basketball, rugby and a fictional football club align with what we know from safety science:
1. Healthcare is a team sport.
Outcomes often depend on coordination and shared understanding more than individual heroics.
2. Shared goals make teams stronger.
Sports teams know what “winning” looks like. In healthcare, this is situational awareness: a shared picture of risks and priorities.
3. Real-time feedback accelerates improvement.
In sport you get immediate performance feedback (a scoreboard). In clinical work, simple tools such as quick debriefs, annotated run charts and one-page dashboards, can play a similar role.
4. Processes must evolve.
Opponents adapt; teams revise their plays. Healthcare protocols need the same updates or they easily become “tick-box” routines.
5. Psychological safety is a competitive advantage.
In sport, players improve when they can try, fail and iterate. In healthcare, a just culture that balances system learning and fair accountability makes it safe to speak up, escalate concerns and learn from error.
Many South African hospitals are working to build this kind of culture. While team-based practice and joint training may still be more the exception than the rule, the direction of travel is clear.
Conclusions
Professional sport is entertainment, but also a window on how groups perform under pressure. Technical skill definitely matters, but the next big gains in healthcare safety may come from adaptability, teamwork and shared learning.
Safety is not only the absence of error; it’s the presence of resilience. Strengthening relationships, refreshing routines, practising for variability and creating safe spaces for reflection can help healthcare teams deliver safer, more reliable care, even when conditions are unpredictable.
Footnote
In the 2025 NBA playoffs, the Cavaliers were defeated by the Indiana Pacers; injuries and new tactics from their opponents disrupted their rhythm. Sport, like healthcare, offers no guarantees. But strong culture and adaptability increase the winning odds.