This model's application is not limited to any particular health care setting. Each part of the cascade occurs in different ways in all parts of the health care system. The cascade can evolve entirely within a single health care location or across organizational boundaries. Trickles make virtually no noise, leave behind little trace of their existence and are mostly absorbed unseen. Their immediate consequences are inconveniences, frustrations and irritations that are frequently addressed as they occur, with no expectation that this level of intervention will avert similar problems in the future.
Downstream consequences are usually unknown.
Creeks are more obvious than trickles because they are seen and heard and create barriers to passage. The health care analogy is with mistakes such as prescribing drugs to patients who have an allergy as a contraindication. These mistakes worry clinicians because of the potential seriousness of the harm they could cause patients. The immediate consequences of these threats to patient safety are often dealt with in the setting in which they are detected. Upstream sources are seldom explored, and downstream consequences are often unknown.