Objective To address the current predicament of fragmented concepts, passive orientation and inefficient coordination in peacetime medical safety management in military medical institutions, to propose and demonstrate an overarching concept of military medical adverse events, and to build a comprehensive governance framework covering the whole spectrum from hidden dangers to accidents and integrating technical and human factors, so as to provide a unified theoretical support for the improvement of the ability of safety governance in military peacetime medical care. Methods The limitation of traditional concepts such as medical accidents and medical disputes was systematically analyzed, while the necessity and scientificity of the new concept were demonstrated. Based on the Swiss cheese model and Heinrich's law, the core connotation of the new concept, including systematicity, processuality and preventability, was explained, and a two-dimensional classification grading management model was constructed. Results The concept of military medical adverse events was clearly defined, revealing that it was the result of multiple layers of defense failure and quantitative and qualitative changes of risks in the medical system. A structured governance model was constructed, including three-dimensional classification (technical, managerial, behavioral) and three level response (department/post level, institution/military internal level, military civil/strategic level), which provided an operational path for risk early warning, root cause analysis (RCA) and graded disposal. Conclusions This concept breaks through the limitations of traditional fragmented management, and shifts the governance focus from post-event handling to pre-event prevention and system improvement, helping military medical institutions build an active defense-oriented safety culture and facilitating a paradigm shift from individual accountability to system learning, which provides theoretical basis for the improvement of the resilience and safety governance capacities of military peacetime medical service system.