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 Pringle.

But while these activities might seem to satisfy the definitions above, they differ from the present model of SEA in two important respects.

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 great difficulty.

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.