Organisational Resilience

The topic of Resilience is evident across a range of disciplinary perspectives including psychology, ecology, business and safety science. It is about coping with new demands and responding effectively. We are interested in investigating resilience from an organisational perspective.

Organisational resilience is influenced by factors beyond the resilience of individuals, and is a property of the working environment. From an organisational perspective resilience is thought to involve four capacities [1]:

  • The ability to respond safely to problems as they occur. An organisation must know how and when to respond, and finally have the resources necessary to implement the response safely.
  • The ability to learn from experience and share that experience. Compiling extensive accident statistics or populating databases is not the same as learning.
  • The ability to monitor how things are going. Monitoring must be based on valid leading indicators, i.e., reliable precursors for events that are about to happen.
  • The ability to anticipate future needs. It is necessary to acknowledge that the future is uncertain and be willing to use new ways of thinking.

Resilience Engineering aims to enhance these capabilities at all levels of organisations.

How can Resilience Engineering be used to Improve Patient Safety?

Patient safety can be improved by changing the design of equipment. For example, it is no longer possible to accidently use the wrong route for spinal (intrathecal) medication. This is because the connectors to drug administration devices have been changed so that one size does not fit all routes [2]. Undeniably, not all threats to patient safety can be mitigated by the redesign of equipment. In many cases, interventions are about changing human behaviour. However, telling people to “blindly” follow the new clinical protocol or forcing them to use the new IT system does not always work. This is because new interventions may introduce unforeseen outcomes that clash with how the healthcare system copes with the complexity of patient care [3].

Time, attention and resources may be wasted on interventions that do not enhance the resilience of organisations. Resilience Engineering provides the means for organisations to target resource investments by integrating safety and efficiency concerns [4]. A resilient organisation should be continually developing and testing new ways of improving safety, with the variability of the working environment in mind. It should have the capacity to adjust work practice to cope with new demands by engineering multiple paths to successful patient care.

Case Study

Shift changes have long been viewed as risky because failures in the transfer of information can result in adverse events. Wears et al. [5] observed shift transitions as part of a study on safety in emergency care. They found that, in addition to being an expected point of failure, transitions were also, unexpectedly, associated with recovery from failure. In fact, transitions have the potential to prevent, detect, or mitigate failures. A resilience engineering approach can maximise this potential.

References

[1] Hollnagel, E. How Resilient is your Organisation? Sustainable Transformation: Building a Resilient Organization, Toronto: Canada (2010). Available from: http://hal.archives-ouvertes.fr/docs/00/61/39/86/PDF/RAGdiscussion_APR05.pdf

[2] T.M. Cook. Non-Luer connectors: are we nearly there yet? Anaesthesia, 67 (2012), pp. 784–792.

[3] Nemeth C, Wears R, Woods DD, et al. Minding the Gaps: Creating Resilience in Health Care. In: Henriksen K, Battles JB, Keyes MA, et al., editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug. Available from: http://www.ncbi.nlm.nih.gov/books/NBK43670/

[4] Woods DD, Wreathall J. Stress-strain plots as a basis for modeling organizational resilience. In: Hollnagel E, Nemeth C, Dekker S, editors. Resilience engineering: Remaining open to the possibility of failure. Aldershot, UK: Ashgate Publishing; 2008. pp. 145–161.

[5] Wears, R. L., Perry, S. J., Shapiro, M., Beach, C., Croskerry, P., & Behara, R. (2003, October). Shift changes among emergency physicians: best of times, worst of times. Human Factors and Ergonomics Society Annual Meeting (Vol. 47, No. 12, pp. 1420-1423). SAGE Publications.

 

By Jonathan Back

CARe

Our primary goals are to develop, implement and test interventions to increase organisational resilience, and to disseminate new ideas about safety throughout the NHS. Our applied work focuses on learning from successful patient outcomes and not just from failures.