Resilient Health Care, Volume 2 The Resilience of Everyday Clinical Work Ashgate Studies in Resilience Engineering Series

Health systems everywhere are expected to meet increasing public and political demands for accessible, high-quality care. Policy-makers, managers, and clinicians use their best efforts to improve efficiency, safety, quality, and economic viability. One solution has been to mimic approaches that have been shown to work in other domains, such as quality management, lean production, and high reliability. In the enthusiasm for such solutions, scant attention has been paid to the fact that health care as a multifaceted system differs significantly from most traditional industries. Solutions based on linear thinking in engineered systems do not work well in complicated, multi-stakeholder non-engineered systems, of which health care is a leading example. A prerequisite for improving health care and making it more resilient is that the nature of everyday clinical work be well understood. Yet the focus of the majority of policy or management solutions, as well as that of accreditation and regulation, is work as it ought to be (also known as ?work-as-imagined?). The aim of policy-makers and managers, whether the priority is safety, quality, or efficiency, is therefore to make everyday clinical work - or work-as-done - comply with work-as-imagined. This fails to recognise that this normative conception of work is often oversimplified, incomplete, and outdated. There is therefore an urgent need to better understand everyday clinical work as it is done. Despite the common focus on deviations and failures, it is undeniable that clinical work goes right far more often than it goes wrong, and that we only can make it better if we understand how this happens. This second volume of Resilient Health Care continues the line of thinking of the first book, but takes it further through a range of chapters from leading international thinkers on resilience and health care. Where the first book provided the rationale and basic concepts of RHC, the Resilience of Everyday Clinical Work b

Academic and Professional Practice & Development

Robert L. Wears (MD; MS, computer science; PhD, industrial safety) is Professor of Emergency Medicine at the University of Florida Health Science Center - Jacksonville, and Visiting Professor in the Clinical Safety Research Group, Imperial College London. He is a practicing emergency physician and has since 1994 been studying safety in healthcare settings. His specific areas of interest include resilience in small work teams, response to the unexpected, the design of artefacts to support distributed cognition, and the impact of computerized information technology on safety and performance. He has authored over 250 papers, book chapters, and essays, the most recent title being Patient Safety: A Brief but Spirited History (in Zipperer, Patient Safety: Perspectives on Evidence, Information and Knowledge Transfer; Gower, 2014). He is Senior Associate Editor of Annals of Emergency Medicine, and serves on the Editorial Boards of Human Factors and the Journal of Patient Safety. He is also a member of the Board of Directors of the Emergency Medicine Patient Safety Foundation. Erik Hollnagel (PhD, psychology) is Professor at the University of Southern Denmark, Chief Consultant at the Centre for Quality Improvement, Region of Southern Denmark, and Professor Emeritus at University of Linköping (Sweden). He has since 1971 worked at universities, research centres, and industries in several countries, most recently as Industrial Safety Chair at MINES ParisTech (France). He has worked with problems from many domains including nuclear power generation, off-shore, aerospace and aviation, air traffic management, software engineering, healthcare, and land-based traffic. His professional interests include industrial safety, resilience engineering, accident investigation, cognitive systems engineering and cognitive ergonomics. He has published more than 250 papers and authored or edited 20 books, some of the most recent titles being The Functional Resonance Analysis Method (Ashgate, 2