Safer: Raj Panjabi on How Healthcare Learned to Accept the Unacceptable

Raj Panjabi's Safer: A Playbook—Turning Fear into Action and Crisis into Community (HarperOne: October 13) is a clear, practical meditation on why societies—and healthcare systems in particular—so often tolerate failing systems until collapse becomes obvious. Drawing on Panjabi's experiences from fleeing Liberia's civil war to treating Ebola in West Africa, managing COVID-19 at Mass General Brigham, and coordinating pandemics on the White House National Security Council, the book insists that connection and belonging—not lone acts of bravery—are the strongest defenses in both sudden and slow-moving crises.

Eight Elements That Shape Crisis

Panjabi organizes his playbook around eight recurring features of crisis: denial, isolation, risk, change, conflict, vulnerability, adaptation, and persistent uncertainty. Each chapter pairs vivid medical and public-health stories with psychological insight and closes with practical tools leaders can use to identify and respond earlier.

• Denial and Normalcy Bias: The tendency to assume the future will look like the present, which helps explain why institutions often miss slow threats.
• Isolation and Connection: Community and belonging are the antidotes to fear.
• Risk Reframed: Risk is not only biomedical—transportation, language, and economic barriers matter too.
• Change and Adaptation: Systems must practice flexibility and rapid learning, not rigid planning.

A Personal Story and a Universal Lesson

The book's most intimate episode concerns Panjabi's daughter, who dropped on growth charts as an infant. What began as assumed picky eating became, after months and alarming symptoms, a diagnosis of dilated cardiomyopathy. She spent weeks in a pediatric ICU, endured years of medication, and recovered. Panjabi writes that this experience crystallized his awareness of normalcy bias: the ease with which we accept deteriorating conditions as merely the new normal.

"The opposite of fear is not bravery. It's belonging," Panjabi writes—summarizing his central thesis that connection, not solitary heroism, sustains people through crisis.

Why This Matters for U.S. Healthcare

The article argues that despite measurable improvements in quality and safety, U.S. healthcare has become more difficult to access, costlier, and often dehumanizing. Chronic disease—responsible for most spending—illustrates the reactive mindset: systems wait for heart attacks, detectable tumors, or visible dementia before acting. Panjabi warns we may be nearing a 'moment of liminality'—a tipping point after which previous norms cannot be restored—unless leaders notice and act earlier.

Practical Steps for Leaders

1. Name What Is Happening: Say plainly when a situation is not normal. Naming removes the comfort of inevitability.
2. Rehearse Before Crisis: Run premortems, tabletop exercises, and low-stakes simulations so teams can learn and adapt.
3. Make Room for Dissent: Institutionalize red-teaming, protect dissenting voices, and build real psychological safety.
4. Hold Purpose Firmly, Plans Loosely: Favor rapid experiments and iterative pivots over fixed blueprints.
5. Prioritize Social Determinants: Treat transportation, housing, language access, and economic supports as core to health care.
6. Humanize Authority: Build trust by admitting limits and acknowledging when systems—and leaders—have failed.

Panjabi's playbook complements other critiques—such as those in The Moral Alibi—about how organizations rationalize failure. Together they suggest the same remedy: notice the slow-moving problems, stop normalizing dysfunction, and commit to concrete experiments and community-centered responses.

Originally published on Forbes.com.