People, systems and safety: resilience and excellence in healthcare practice

Abstract

Summary This article outlines recent developments in safety science. It describes the progression of three ‘ages’ of safety, namely the ‘age of technology’, the ‘age of human factors’ and the ‘age of safety management’. Safety science outside healthcare is moving from an approach focused on the analysis and management of error (‘Safety‐1’) to one which also aims to understand the inherent properties of safety systems that usually prevent accidents from occurring (‘Safety‐2’). A key factor in the understanding of safety within organisations relates to the distinction between ‘work as imagined’ and ‘work as done’. ‘Work as imagined’ assumes that if the correct standard procedures are followed, safety will follow as a matter of course. However, staff at the ‘sharp end’ of organisations know that to create safety in their work, variability is not only desirable but essential. This positive adaptability within systems that allows good outcomes in the presence of both favourable and adverse conditions is termed resilience. We argue that clinical and organisational work can be made safer, not only by addressing negative outcomes, but also by fostering excellence and promoting resilience. We outline conceptual and investigative approaches for achieving this that include ‘appreciative inquiry’, ‘positive deviance’ and excellence reporting.

Development and initial psychometric testing of the Intrahospital Transport Safety Scale in intensive care

“…7 However, we suggest that environmental deficiencies might be under-reported in the IHT literature as healthcare practitioners tend to adapt their work to cope with system design flaws. 50 Importantly, our findings show that the physical layout and design of the hospital setting, including the ICU setting and rooms and the destination site, were important to perform transfers safely. Finally, teamwork includes attributes such as knowledge, skills and attitudes among team members and the team structure.…”

Variation in electronic test results management and its implications for patient safety: A multisite investigation

“…This need to support “memory of pending tasks” 36 for managing test results and using paper-based strategies in HIT-enabled settings such as sticky notes, 17 , 35 lists, and logs, has been previously reported in the literature 17 , 18 , 35 , 36 and characterized as “workarounds.” 35 The paper and electronic tracking strategies we identified meet the definition of workarounds stated in Debono et al as “observed or described behaviors that may differ from organizationally prescribed or intended procedures.” 45 The context surrounding our participants’ adoption of workarounds are indicative of clinicians actively employing strategies to support the cognitive demands of tracking test results through to follow-up and completion. Thus, they also fall under the definition of resilience stated in Smith et al as “positive adaptability within systems that allows good outcomes in the presence of both favourable and adverse conditions.” 46 Although resilience strategies can maximize positive outcomes, they also risk obscuring underlying barriers or threats to safety. 47 , 48 Accordingly, the findings of the current study have implications for the safety of electronic test results management as they identify a need for HIT to support clinicians in tracking test results, and especially those that return after a patient has been discharged.…”

The Lilypond: An integrated model of Safety II principles in the workplace. A quantum shift in patient safety thinking

“…If there is an opportunity to learn from the worst possible outcomes, there should equally be opportunities to learn valuable lessons from successful events. 8 A balanced approach to measuring and learning from all outcomes would be a powerful shift towards a Safety II approach. It does, however, still utilise some vestiges from traditional Safety I.…”