Where did SEA come from?
The history of individual case review has been traced back to ancient times.
Certainly since time immemorial doctors have studied their successes and
failures in an attempt to do better. But
the systematic team approach of SEA dates back probably only to the American Air
Force development of Critical Incident Review in the Second World War.
Effective and ineffective examples of leadership in combat were analysed
so that accurate job descriptions and thus training needs could be identified.
This successful approach diffused through associated fields – aviation
authorities and the aero and engineering industries for example – finding its
way into health care only latterly.
Some suggest that the various confidential
enquiries into maternal, anaesthetic and peri-operative deaths along with the
traditional grand round and clinico-pathological conferences show that SEA was
practised widely before its more recent rediscovery and redevelopment by
But while these activities might seem to satisfy
the definitions above, they differ from the present model of SEA in two
First, they are all concerned with problems (more or less intractable),
failures, disasters or near misses. SEA
allows for – indeed encourages – the identification of successful behaviours
and episodes of care, even to finding instances of good practice at moments of
Second, they share a formality if not grandeur, which is signally lacking in
SEA. SEA is a work based reflective
activity, with a potentially anti-hierarchical tendency: it involves
- indeed helps to identify - a small group of people who share a working
environment, ‘the team’. These
members depend upon each other, needing and providing mutual support.
They are accustomed to learning with and from each other. The member who
presents the incident often leads the SEA process. Although there is no inquisitional or punitive flavour, such
an approach is still detailed, systematic and at times exhaustive.