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1. The scope of Resilient Health Care
When designing and implementing new digital health systems, the safety of those
systems for clinicians and the patients in their care must be a core consideration.
Resilient Health Care (RHC) is a relatively new approach to safety, albeit with long
antecedents to resilience engineering, that shifts from understanding safety as the
absence of accidents or incidents, to thinking of safety as a system where as many
things as possible go well. Measuring what goes wrong has been an attractive concept
for organisations in the past: there are typically few things to count, and resources can
usually be brought to bear to tackle problems that have been shown to result in
significant harm. Traditional approaches to safety are reactive rather than proactive;
examples include regulation,[1] protocols and checklists,[2-5] Root Cause Analyses[6]
and judicial inquiries to investigate patient deaths.[7] Errors after they occur are
identified and rectified, and processes are put in place in an attempt to prevent future
occurrences. This approach is not effective, however, where the route to error is
different on each occasion, and where fixes for previous errors can contribute to new
paths to failure. In contrast, RHC asks us to understand how the systems requiring
action actually work, to identify what goes right and comprehend why things routinely
go well, and to proactively manage variability in the workplace. This newer way of
thinking is necessary for the whole gamut of systems behaviour. It is especially
apposite for improving safety in complex adaptive systems such as healthcare, and has
been driven by failure to improve the safety of patient care by traditional means,
despite more than two decades of effort.[8]
A complex adaptive system is one with multiple interacting and interdependent
parts that change continuously and dynamically in response to environment or
conditions.[9] In healthcare, these components consist primarily of humans, such as
clinicians, patients and their families, aided by affordances such as technological
artefacts and equipment. Human performance is inherently variable; regardless of their
experience and ability, for example, the performance of an individual clinician will
vary depending on the problem, time of day, and so on. Furthermore, clinicians work in
small, medium and large ad hoc teams, and must interact with a range of other
healthcare professionals whose performance is also varying. When the variability
associated with patients and their illness or injury is also taken into account, the result
is a complex and unpredictable system. Due to the complex and dynamic nature of the
interactions of components, outcomes from a complex adaptive system can be
unexpected and unable to be attributed to specific inputs—this is what is known as
emergent behaviour. In addition, the system’s history plays a part in determining where
things are now; this is called ‘path dependence’.[10]
As RHC grew from the field of resilience engineering, it borrowed from resilience
engineering theory, which conceptualises how normal variation in task performance in
socio-technical systems can lead to both wanted and unwanted outcomes. This guides
research into how variation in human performance of everyday work processes
contributes to both failure (i.e. unwanted outcome or ‘error’) and success (i.e. wanted
outcome). The theory is grounded in system thinking and complexity science, and in
understanding how systems typically cope successfully with unwanted outcomes (or
events) that are unexpected. Resilience engineering originated in 2005, at a gathering of
influential industrial safety scholars led by Erik Hollnagel, David Woods and Nancy
Leveson,[10] and emerged from the work of Crawford Holling on ecological
systems[11] and Charles Perrow on normal accidents.[12] The application of resilience
R.Clay-WilliamsandJ.Braithwaite /ResilientHealthCare 135
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Buch Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Titel
- Applied Interdisciplinary Theory in Health Informatics
- Untertitel
- Knowledge Base for Practitioners
- Autoren
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Verlag
- IOS Press BV
- Ort
- Amsterdam
- Datum
- 2019
- Sprache
- englisch
- Lizenz
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Abmessungen
- 16.0 x 24.0 cm
- Seiten
- 242
- Kategorie
- Informatik