Paper: Implementing resilience engineering for healthcare quality improvement

This paper provides an overview of our research approach at the Centre for Applied Resilience in Healthcare.

Anderson, J. E., Ross, A., Back, J., Duncan, M., Snell, P., Walsh, K. and Jaye, P. (2016). Implementing resilience engineering for healthcare quality improvement using the CARE model: a feasibility study protocol. Pilot and Feasibility Studies. DOI: 10.1186/s40814-016-0103-x Download


Please feel free to contact us if you wish to discuss further.

Resilience engineering (RE) is an emerging perspective on safety in complex adaptive systems that emphasises how outcomes emerge from the complexity of the clinical environment. Complexity creates the need for flexible adaptation to achieve outcomes. RE focuses on understanding the nature of adaptations, learning from success and increasing adaptive capacity. Although the philosophy is clear, progress in applying the ideas to quality improvement has been slow. The aim of this study is to test the feasibility of translating RE concepts into practical methods to improve quality by designing, implementing and evaluating interventions based on RE theory. The CARE model operationalises the key concepts and their relationships to guide the empirical investigation.

The settings are the Emergency Department and the Older Person’s Unit in a large London teaching hospital. Phases 1 and 2 of our work, leading to the development of interventions to improve the quality of care, are described in this paper. Ethical approval has been granted for these phases. Phase 1 will use ethnographic methods, including observation of work practices and interviews with staff, to understand adaptations and outcomes. The findings will be used to collaboratively design, with clinical staff in interactive design workshops, interventions to improve the quality of care. The evaluation phase will be designed and submitted for ethical approval when the outcomes of phases 1 and 2 are known.

Study outcomes will be knowledge about the feasibility of applying RE to improve quality, the development of RE theory and a validated model of resilience in clinical work which can be used to guide other applications. Tools, methods and practical guidance for practitioners will also be produced, as well as specific knowledge of the potential effectiveness of the implemented interventions in emergency and older people’s care. Further studies to test the application of RE at a larger scale will be required, including studies of other healthcare settings, organisational contexts and different interventions.

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Second Resilience in Health Care Masterclass

Our second Masterclass will be held November 10th and 11th in Bristol. It will be held at the Bristol Mercure Holland House Hotel and Spa, which is a short walk from Bristol Temple Meads station with frequent trains to and from London. There is also on site parking and a swimming pool, fitness suite and spa. The keynote speaker will be Dr. Mark Sujan from the University of Warwick. His talk title is “Reporting and learning – A Safety-II perspective”. Registration is now open and further details can be found on the masterclass page on this site.

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Video Game Project

CARe is hiring an experienced game developer for a September-October 2016 contract.

The successful candidate will help us translate our research findings into a scenario-based game for people who work with patients, like nurses and doctors.

Please see the Job Posting for details.

Send your completed application to by August 15, 2016.

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Rachel Jennings research placement

After an inspiring research placement with colleagues from the CARe team in April 2016, Rachel Jennings, a second year BSc Adult Nursing student has been invited to spend two weeks in July at the University of Melbourne & Peter MacCallum Cancer Centre working alongside Professor Mei Krishnasamy. Rachel commented:

‘‘I will be further exploring the role of an academic in a clinical centre, and look forward to the learning opportunities that this experience of a new environment will bring.’’

We wish Rachel the very best of luck for her upcoming research placement in Australia and also for the rest of her undergraduate studies.


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Jennifer Jackson PhD research student

CARe welcomes Jennifer Jackson to the team!

Jennifer is a Registered Nurse, with a clinical practice background in critical care, and a research interest in nursing resilience in the context of an organization. As a master’s student at Athabasca University, Jennifer studied the process of resilience for critical care nurses. She is expanding this work at King’s College London, as an international post graduate researcher at the Florence Nightingale Faculty of Nursing and Midwifery.

Jennifer is also a leader in nursing education and communications. She spearheaded the launch of several social media programs in Canada, including the Canadian Nurses Foundation’s Nursing Week campaigns. Jennifer connects technology and health care, improving nursing education and patient safety. Her passions include social justice, advocacy, resilience, and caring for the caregiver.

The CARe team page

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Matthew Alders PhD research student

CARe welcomes Matthew Alders to the team!

Matthew Alders is a PhD research student at the Florence Nightingale Faculty of Nursing and Midwifery (FNFNM). Matthew’s research project with CARe is concerned with defining and measuring resilience in healthcare settings.

Before starting his postgraduate studies Matthew successfully completed a BSc in Adult Nursing at FNFNM. Since qualifying he has worked as a Staff Nurse on the Acute Assessment Unit at the Royal London Hospital. Matthew also has a BA in Philosophy from the University of Warwick.

The CARe team page

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UPDATED: *7-8th May 2015 – Resilience in Healthcare Masterclass*

We are pleased to announce a course for researchers and health professionals who want to learn how to apply resilience engineering concepts to improve care quality and safety. Organised by us!

Book your place here:

For further information please email:

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Our working model of organisational resilience

Our current working model of organisational resilience allows us to identify the key theoretical concepts that we are interested in and the relationships between them so that we can investigate them empirically. Please see our fact sheet

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11th November 2014 – ASPiH Simulation training for resilient healthcare

Erik Hollnagel and the CARe team will be presenting an ASPiH pre-conference course on Simulation training for resilient healthcare. This will take place on 11th November 2014 in Nottingham. Please see the ASPiH2014 conference brochure for further details or the ASPiH Website.

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Royal College of Anaesthetists talk

Al Ross was invited to the Royal College of Anaesthetists on 16th July, where he spoke on the psychological basis for Safety II, and resilience-based approaches to safety.

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