Resilient Health Care – Making steady progress

Hollnagel, Erik; Sujan, Mark; Braithwaite, Jeffrey

doi:10.1016/j.ssci.2019.07.029

Cited by 29 publications

(48 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This gap is closely related to the terms work-as-imagined (WAI) and work-as-done (WAD) in the resilience healthcare literature 63. Hollnagel64 describes WAI as an idealised view of how tasks should be performed in a system, where there is an assumption that work tasks can be completely analysed and prescribed, as, for example, has been done in the Commissioners’ documents. However, in reality, where the tasks are being performed, conditions are constantly changing (eg, in workload), creating a discrepancy between the WAI and WAD 64.…”

Section: Discussionmentioning

confidence: 99%

“…Hollnagel64 describes WAI as an idealised view of how tasks should be performed in a system, where there is an assumption that work tasks can be completely analysed and prescribed, as, for example, has been done in the Commissioners’ documents. However, in reality, where the tasks are being performed, conditions are constantly changing (eg, in workload), creating a discrepancy between the WAI and WAD 64. In relation to the Commissioners’ documents, the results from the current study suggest that the context in which care decisions are made has not been considered.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Hospital physicians’ views on discharge and readmission processes: a qualitative study from Norway

et al. 2019

View full text Add to dashboard Cite

ObjectivesTo explore hospital physicians’ views on readmission and discharge processes in the interface between hospitals and municipalities.DesignQualitative case study.SettingThe Norwegian healthcare system.ParticipantsFifteen hospital physicians (residents and consultants) from one hospital, involved in the treatment and discharge of patients.ResultsThe results of this study showed that patients were being discharged earlier, with more complex medical conditions, than they had been previously, and that discharges sometimes were perceived as premature. Insufficient capacity at the hospital resulted in pressure to discharge patients, but the primary healthcare service of the area was not always able to assume care of these patients. Communication between levels of the healthcare service was limited. The hospital stay summary was the most important, and sometimes only, form of communication between levels. The discharge process was described as complicated and was affected by healthcare personnel, by patients themselves and by aspects of the primary healthcare service. Early hospital discharges, poor communication between healthcare services and inadequacies in the discharge process were perceived to affect hospital readmissions.ConclusionThe results of this study provide a better understanding of hospital physicians’ views on the discharge and hospital readmission processes in the interface between the hospital and the primary healthcare service. The study also identifies discrepancies in governmental requirements, reform regulations and current practices in municipalities and hospitals.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hospital physicians’ views on discharge and readmission processes: a qualitative study from Norway

et al. 2019

View full text Add to dashboard Cite

show abstract

“…These diverse theories and models about resilience and the interest in understanding how complex systems continue to operate and deliver services despite stress, disruptions, unforeseen events, and insufficient resources and competence, have also informed and shaped health services research (e.g. [10][11][12][13][14][15][16][17]). It follows, resilient healthcare is a growing research field that seeks to understand and improve system functioning to deliver high quality and safe patient care.…”

Section: The Importance Of Defining Resiliencementioning

confidence: 99%

“…In the Concepts for Applying Resilience Engineering (CARE) model, Anderson et al [28] describe the adjustments and adaptations needed to align work-as-imagined (WAI) with work-as-done (WAD). WAI and WAD are key concepts in resilience engineering and highlight differences in the work as intended and described in procedures, regulation and management instructions (WAI), compared to how work in practice often differs from this due to the complexity of the system and local work practices [10,17]. The CARE model focuses on misalignments between demand and capacity, and how these create the need for adaptations in practice.…”

Section: A Brief Overview Of Key Constructs In Resilience Engineeringmentioning

confidence: 99%

Defining the boundaries and operational concepts of resilience in the resilience in healthcare research program

Wiig

Aase

Billett

et al. 2020

BMC Health Serv Res

193

257

View full text Add to dashboard Cite

Background: Understanding the resilience of healthcare is critically important. A resilient healthcare system might be expected to consistently deliver high quality care, withstand disruptive events and continually adapt, learn and improve. However, there are many different theories, models and definitions of resilience and most are contested and debated in the literature. Clear and unambiguous conceptual definitions are important for both theoretical and practical considerations of any phenomenon, and resilience is no exception. A large international research programme on Resilience in Healthcare (RiH) is seeking to address these issues in a 5-year study across Norway, England, the Netherlands, Australia, Japan, and Switzerland (2018-2023). The aims of this debate paper are: 1) to identify and select core operational concepts of resilience from the literature in order to consider their contributions, implications, and boundaries for researching resilience in healthcare; and 2) to propose a working definition of healthcare resilience that underpins the international RiH research programme. Main text: To fulfil these aims, first an overview of three core perspectives or metaphors that underpin theories of resilience are introduced from ecology, engineering and psychology. Second, we present a brief overview of key definitions and approaches to resilience applicable in healthcare. We position our research program with collaborative learning and user involvement as vital prerequisite pillars in our conceptualisation and operationalisation of resilience for maintaining quality of healthcare services. Third, our analysis addresses four core questions that studies of resilience in healthcare need to consider when defining and operationalising resilience. These are: resilience 'for what', 'to what', 'of what', and 'through what'? Finally, we present our operational definition of resilience. Conclusion: The RiH research program is exploring resilience as a multi-level phenomenon and considers adaptive capacity to change as a foundation for high quality care. We, therefore, define healthcare resilience as: the capacity to adapt to challenges and changes at different system levels, to maintain high quality care. This working definition of resilience is intended to be comprehensible and applicable regardless of the level of analysis or type of system component under investigation.

show abstract

“…between structure and agency (Furniss et al, 2019b). A recent special issue on Resilient Health Care in the journal Safety Science (Hollnagel et al, 2019) included several papers that demonstrated how FRAM might be used to describe and to understand performance variability in healthcare settings. For example, FRAM has already been applied to show some of the complexity of drug administration on a neonatal intensive care unit in Turkey, which gives examples of error occurrence and recovery (Kaya et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Using FRAM to explore sources of performance variability in intravenous infusion administration in ICU: A non-normative approach to systems contradictions

et al. 2020

Self Cite

View full text Add to dashboard Cite

Systems contradictions present challenges that need to be effectively managed, e.g. due to conflicting rules and advice, goal conflicts, and mismatches between demand and capacity. We apply FRAM (Functional Resonance Analysis Method) to intravenous infusion practices in an intensive care unit (ICU) to explore how tensions and contradictions are managed by people. A multi-disciplinary team including individuals from nursing, medical, pharmacy, safety, IT and human factors backgrounds contributed to this analysis. A FRAM model investigation resulting in seven functional areas are described. A tabular analysis highlights significant areas of performance variability, e.g. administering medication before a prescription, prioritising drugs, different degrees of double checking and using sites showing early signs of infection for intravenous access. Our FRAM analysis has been non-normative: performance variability is not necessarily wanted or unwanted, it is merely necessary where system contradictions cannot be easily resolved and so adaptive capacity is required to cope.

show abstract

Resilient Health Care – Making steady progress

Cited by 29 publications

References 0 publications

Hospital physicians’ views on discharge and readmission processes: a qualitative study from Norway

Hospital physicians’ views on discharge and readmission processes: a qualitative study from Norway

Defining the boundaries and operational concepts of resilience in the resilience in healthcare research program

Using FRAM to explore sources of performance variability in intravenous infusion administration in ICU: A non-normative approach to systems contradictions

Contact Info

Product

Resources

About