A resilience engineering approach to improving patient safety and quality of healthcare
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Patient safety is a core issue in healthcare today with a large number of patient deaths and other adverse events associated with the care-giving process. The traditional approaches to safety which focus on finding and eliminating the 'root-causes' of failure have only been minimally effective. Resilience Engineering (RE) is a new field that marks a paradigm shift in the safety sciences. Instead of looking at what goes wrong, the focus of RE is on understanding and supporting what goes right. In other words, the emphasis is on unraveling and enhancing the sources of resilience in a system. The overall objective of this research was to apply the principles of RE toward improving patient safety and quality of healthcare. The specific aims were threefold: (i) to interview healthcare workers about how they ensure patient safety in challenging situations; (ii) to analyze the data and cross-validate findings with the existing conceptual framework of RE; and (iii) to create a tool for employees across the healthcare organization to report examples of resilience from their own practice, and perform a preliminary evaluation of the tool. A multi-phase research was planned to achieve these objectives. In the first phase, an interview guide was created based on traditional critical incident interviewing techniques. The guide was adapted to elicit resilience-related information from frontline and managerial staff in health care, particularly in terms of achieving patient safety. Eighteen interviews were conducted with clinicians, nurses and safety administrators from a large, multi-hospital medical system. In the second phase, the interviews were analyzed and various factors pertinent to patient safety were extracted. These factors were aligned with the essential capabilities of a resilient system - learning, responding, anticipating and monitoring. Results indicated that the capabilities manifested in different ways across different system levels - from the individual practitioner to teams to the senior management level. A Resilience Mapping Framework (RMF) was developed to systematically map resilience against specific issues across the organization. In the third phase, the analysis of the interviews was used to develop a Resilience Engineering Tool to Improve Patient Safety (RETIPS) that can be implemented organization-wide for reporting and analysis of resilience-based cases. The research has several implications, both in terms of developing the theoretical framework of RE as well for the improvement of patient safety. RETIPS can be used by hospitals to learn about the resilience capabilities that emerge from the frontlines of care and inform policy-making. The RMF can be used by the hospital's safety administration to identify hidden risks as well as opportunities to improve resilience and safety.