Safety-II and Resilience Engineering in a Nutshell: An Introductory Guide to Their Concepts and Methods

Ham, Dong-Han

doi:10.1016/j.shaw.2020.11.004

Cited by 44 publications

(19 citation statements)

References 42 publications

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“…In comparison with the traditional risk assessment that tried to reduce the causes of accident and prepare control measures to mitigate the effects in case of an event, the actual concept of resilience engendering claims that a system is resilient if it can adjust to disturbances through anticipation, monitoring, responding, and learning [22 ▪ ].…”

Section: Is It Time To Focus On Resilience Too?mentioning

confidence: 99%

Learning from errors and resilience

Velasco

Heras-Hernando

2023

Current Opinion in Anaesthesiology

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Purpose of reviewLearning from errors has been the main objective of patient safety initiatives for the last decades. The different tools have played a role in the evolution of the safety culture to a nonpunitive system-centered one. The model has shown its limits, and resilience and learning from success have been advocated as the key strategies to deal with healthcare complexity. We intend to review the recent experiences in applying these to learn about patient safety.Recent findingsSince the publication of the theoretical basis for resilient healthcare and Safety-II, there is a growing experience applying these concepts into reporting systems, safety huddles, and simulation training, as well as applying tools to detect discrepancies between the intended work as imagined when designing the procedures and the work as done when front-line healthcare providers face the real-life conditions.SummaryAs part of the evolution in patient safety science, learning from errors has its function to open the mindset for the next step: implementing learning strategies beyond the error. The tools for it are ready to be adopted.

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Section: Is It Time To Focus On Resilience Too?mentioning

confidence: 99%

Learning from errors and resilience

Velasco

Heras-Hernando

2023

Current Opinion in Anaesthesiology

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“…The patient safety paradigm is concerned with so-called "normal" crises common to modern healthcare including high turnover, cost-effectiveness, and repetition. While literature heavily cites safety1 (adverse event focused) and safety2 (appreciative inquiry approaches) [93], in reality they have developed in parallel, are not mutually exclusive, and may fail to consider established systems thinking approaches [30]. WAI/WAD dichotomies are attempts to match actuality:potentiality ratios and minimise performance variability.…”

Section: Concepts and Framework -Meso-levelmentioning

confidence: 99%

Healthcare resilience - A meta-narrative systematic review and synthesis

Tan

Prager

Mcclelland

et al. 2022

Preprint

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BackgroundResilience is a ubiquitous but often misunderstood term. It is often studied and described within the lens of individual academic disciplines, despite the complexities and interactions of today’s world. Using a meta-narrative approach, we performed a systematic literature review of healthcare resilience, tracking the research traditions which have informed this field. This paper consolidates knowledge about the definitions, measures, and concepts of healthcare resilience at meso- and macro-levels, to build an interdisciplinary, cross-sectoral, and multi-level (ICM) approach and framework. It forms part of a wider project on healthcare resilience, within a larger research group on societal resilience and guides efforts to build resilience after the COVID19 pandemic.MethodsForty-five reviews were analysed thematically, adhering to RAMESES and PRISMA guidelines. We explore issues inherent to fundamental terms and propose a unified definition spanning event timescales and applicable to multiple hierarchical levels. Studies tended to focus on individual hierarchical levels using a range of frameworks, which are frequently also used as measurement indices. Macro-level indices focusing on capacities failed to sufficiently capture the importance of relational aspects of systems resilience. Meso-level approaches and frameworks tended to swing between the extremes of disaster risk reduction strategies and patient safety approaches for normal stressors. Micro-level approaches were not a focus but tended to centre around acute psychological interventions.ResultsThe analysis allowed us to propose a unified definition and build an overall framework for healthcare resilience containing pre-, intra-, post-, and trans-event domains, which work across hierarchical levels. We also adopt a realist view by presenting a table of selected resilience frameworks, categorising them according to predominant hierarchical level and timescale. This aims to guide decision-makers about the suitability of various frameworks, at specific levels, through numerous points during crises. ConclusionThere is increasing acknowledgement of the need for inter-disciplinary, cross-sectoral, and multi-level approaches to healthcare resilience, but such work is hitherto rare. A realist approach to various resilience frameworks may help to determine best-fit for individual organisations and systems. There is a need to better understand how resilience practically works across various hierarchical levels.

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“…Smith and Plunkett have described resilience as the “positive adaptability within systems that allows good outcomes in the presence of both favorable and adverse conditions.” Understanding this proactive adaptability and variability is the foundation of the health care Safety-II framework . In Safety-II, the focus is on how work is done at the frontline by health care professionals in real work conditions (what we refer to as work as done ) to generate acceptable, safe outcomes almost universally ( what goes right ).…”

Section: Introductionmentioning

confidence: 99%

“…Smith and Plunkett 3 have described resilience as the “positive adaptability within systems that allows good outcomes in the presence of both favorable and adverse conditions.” Understanding this proactive adaptability and variability is the foundation of the health care Safety-II framework. 4 In Safety-II, the focus is on how work is done at the frontline by health care professionals in real work conditions (what we refer to as work as done ) to generate acceptable, safe outcomes almost universally ( what goes right ). This is in contrast to the traditional approach to safety management 3 that relies on a conceptualized ( work as imagined ) model of how work should be performed for later comparison after an adverse event ( what went wrong ).…”

Section: Introductionmentioning

confidence: 99%

Clinicians’ Perspectives on Proactive Patient Safety Behaviors in the Perioperative Environment

et al. 2023

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ImportanceThe perioperative environment is hazardous, but patients remain safe with a successful outcome during their care due to staff adaptability and resiliency. The behaviors that support this adaptability and resilience have yet to be defined or analyzed. One Safe Act (OSA), a tool and activity developed to capture self-reported proactive safety behaviors that staff use in their daily practice to promote individual and team-based safe patient care, may allow for improved definition and analysis of these behaviors.ObjectiveTo thematically analyze staff behaviors using OSA to understand what may serve as the basis for proactive safety in the perioperative environment.Design, Setting, and ParticipantsThis qualitative thematic analysis included a convenience sample of perioperative staff at a single-center, tertiary care academic medical center who participated in an OSA activity during a 6-month period in 2021. All perioperative staff were eligible for inclusion. A combined deductive approach, based on a human factor analysis and classification framework, as well as an inductive approach was used to develop themes and analyze the self-reported staff safety behaviors.ExposuresThose selected to participate were asked to join an OSA activity, which was conducted in-person by a facilitator. Participants were to self-reflect about their OSA (proactive safety behavior) and record their experience as free text in an online survey tool.Main Outcome and MeasuresThe primary outcome was the development and application of a set of themes to describe proactive safety behaviors in the perioperative environment.ResultsA total of 140 participants (33 nurses [23.6%] and 18 trainee physicians [12.9%]), which represented 21.3% of the 657 total perioperative department full-time staff, described 147 behaviors. A total of 8 non–mutually exclusive themes emerged with the following categories and frequency of behaviors: (1) routine-based adaptations (46 responses [31%]); (2) resource availability and assessment adaptations (31 responses [21%]); (3) communication and coordination adaptation (23 responses [16%]); (4) environmental ergonomics adaptation (17 responses [12%]); (5) situational awareness adaptation (12 responses [8%]); (6) personal or team readiness adaptation (8 responses [5%]); (7) education adaptation (5 responses [3%]); and (8) social awareness adaptation (5 responses [3%]).Conclusions and RelevanceThe OSA activity elicited and captured proactive safety behaviors performed by staff. A set of behavioral themes were identified that may serve as the basis for individual practices of resilience and adaptability that promote patient safety.

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Safety-II and Resilience Engineering in a Nutshell: An Introductory Guide to Their Concepts and Methods

Cited by 44 publications

References 42 publications

Learning from errors and resilience

Learning from errors and resilience

Healthcare resilience - A meta-narrative systematic review and synthesis

Clinicians’ Perspectives on Proactive Patient Safety Behaviors in the Perioperative Environment

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