Previous risk management practices are largely based on learning from past harm and introducing interventions (new procedures, risk assessments, training) or technical fixes (alerts and prompts in electronic health records) to reduce risk. This process of adding new interventions has largely gone unchecked; many (e.g. Ashton, 2018; Wise, 2018) now argue healthcare systems have become overly constrained without clear evidence of benefit. A recent experiment in Nature (Adams et al., 2021) demonstrates a human tendency towards additive rather than subtractive change. Consequently, people tend to think that doing something additional is more effective than doing less. Here, we will deliver research programmes with the common theme of doing less, or de-cluttering.

Many terms describe the process of reducing the burden of excessive procedures, medicines and alerts, e.g. de-implementation, deprescribing, exnovation. Our lay leaders advised that none of these terms captured the different topics or were accessible to the public. Thus, we use the term de-cluttering to capture how this theme will improve safety by: 1. Reducing ineffective safety practices; 2. Reducing problematic polypharmacy; 3. Rationalising clinical decision support systems.