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\"From operating theatres to trading floors, and from oil platforms to airline cockpits, organizations are engaged in a continuous struggle for safety and control. It has become essential for organizations to identify, understand and learn from close calls and 'near-miss' events quickly, before minor errors and failures can enlarge into catastrophic accidents. This book is about the practical work that transforms moments of risk into sources of resilience. It specifically examines the world of airline flight safety investigators, whose job it is to oversee one of the most technologically advanced, one of the safest, but also one of the least forgiving operational environments that exist: commercial air transport. Drawing on extensive first-hand observations and unique access to major airlines, Close Calls presents a compelling and richly detailed account of the challenges faced by these modern risk managers and the innovative strategies they adopt to analyse risk and improve safety. It is a must-read for all those who seek to understand and improve the oversight, analysis and management of risk and safety in complex organizations. \"-- Provided by publisher.

In the wake of healthcare disasters, such as the appalling failures of care uncovered in Mid Staffordshire, inquiries and investigations often point to a litany of early warnings and weak signals that were missed, misunderstood or discounted by the professionals and organisations charged with monitoring the safety and quality of care. Some of the most urgent challenges facing those responsible for improving and regulating patient safety are therefore how to identify, interpret, integrate and act on the early warnings and weak signals of emerging risks—before those risks contribute to a disastrous failure of care. These challenges are fundamentally organisational and cultural: they relate to what information is routinely noticed, communicated and attended to within and between healthcare organisations—and, most critically, what is assumed and ignored. Analysing these organisational and cultural challenges suggests three practical ways that healthcare organisations and their regulators can improve safety and address emerging risks. First, engage in practices that actively produce and amplify fleeting signs of ignorance. Second, work to continually define and update a set of specific fears of failure. And third, routinely uncover and publicly circulate knowledge on the sources of systemic risks to patient safety and the improvements required to address them.

Seminal reports that launched the modern field of patient safety highlighted the importance of learning from critical incidents. 1 2 Since then, incident reporting systems have become one of the most widespread safety improvement strategies in healthcare, both within individual organisations and across entire healthcare systems. 3 There are some strong examples of learning and improvement following serious patient safety incidents. 4 5 But major disasters have also revealed widespread failures to understand and respond to reported safety incidents. 6 7 Between these two extremes exists a range of frustrations and confusions regarding the purpose and practice of incident reporting. 8-10 These problems can be traced to what was lost in translation when incident reporting was adapted from aviation and other safety-critical industries, 11 with fundamental aspects of successful incident reporting systems misunderstood, misapplied or entirely missed in healthcare. Table 1 Key principles in other industries Common practices in healthcare Focus on reporting incidents that provide serious, specific or surprising insights into system safety Encourage reporting of any and all incidents that may in some way relate to safety concerns Avoid swamping the reporting system to ensure thorough review of all reported incidents Celebrate large quantities of incident reports and aim for ever-increasing overall reporting rates Use incident reports to identify and prioritise significant, new or emerging risks Quantify, count and chart different categories of incident report to monitor performance trends Harness the social processes of reporting to generate increased awareness and reporting of current risks Aim to increase reporting rates to address perceived epidemiological or statistical biases in reported data Expect reports to be inaccurate and incomplete; focus on investigation as the means of obtaining complete picture Improve accuracy of incident reports through more comprehensive data collection processes Apply pragmatic incident taxonomies that support basic analysis, improvement action and retrospective search Expect incident taxonomies to accurately explain and map complex realities Ensure incident reporting systems are managed and coordinated by an operationally independent group Incidents reported to direct supervisors or other operational managers within organisation Reporting constitutes one component of broad range of conversations and activities focused on safety and risk Incident reporting represents the most visible safety activity for many organisations Create regimes of mutual accountability for improvement and peer review of actions around incidents Use reported incident data as an indicator to monitor organisational safety performance Complications, confusions and contradictions The problems that beset incident reporting in healthcare span the confused role of measurement, the unclear relationship with performance management, the underspecified processes of investigation, and the complicated nature of learning and improvement.

Background Human resource management (HRM) of healthcare organisations plays an important role in improving the continuity of care, managing staff, and ensuring patient safety. During COVID-19, there were several HR-related issues, creating a significant challenging situation for health and social care institutions. This study explored the HRM issues that are associated with the patient safety in homecare, and how homecare providers have responded to these HR-related challenges during the COVID-19 pandemic. The aim of this is to explore the role of HRM practices in helping care organisations operate efficiently and supporting their workforce to adapt to future disruptive changes and crises. Methods Qualitative strategies include narrative inquiry involving gathering information in the form of storytelling by the research participants. Between February 2021 and December 2021, data were collected through semi-structured interviews of 31 participants, including homecare staff (homecare transition practitioners, homecare social workers, and carers), family members, and service users in England. Results The research identified key HRM challenges during the pandemic, including staff shortages, high turnover, ineffective communication, occupational stress for front-line carers, and lack of training, all adversely affecting the safety of homecare patients. In response, homecare providers employed strategies like opportunistic recruitment, digital technology for training and communication, and flexible work arrangements to mitigate these issues. Conclusions Several implications are proposed, with the over-riding aim of ensuring effective management of HRM practices in responding to address key areas: staffing, performance management, and training. Homecare providers should utilise short-term adaptive recruitment strategies, while also focusing on long-term workforce development and resilience to effectively respond to current and future care needs. Prioritising staff well-being for retention and care quality are crucial. Homecare providers are encouraged to offer flexible work arrangements and digital communication methods, all while being mindful of preventing technostress and digital exhaustion among their staff. They also need to bridge training gaps and employ effective delivery methods to equip healthcare workers with essential skills, thereby enhancing resilience and adaptability in homecare.

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.

ObjectivesThe current research project sought to map out the regulatory landscape for patient safety in the English National Health Service (NHS).MethodWe used a systematic desk-based search using a variety of sources to identify the total number of organisations with regulatory influence in the NHS; we researched publicly available documents listing external inspection agencies, participated in advisory consultations with NHS regulatory compliance teams and reviewed the websites of all regulatory agencies.ResultsOur mapping revealed over 126 organisations who exert some regulatory influence on NHS provider organisations in addition to 211 Clinical Commissioning Groups. The majority of these organisations set standards and collect data from provider organisations and a considerable number carry out investigations. We found a multitude of overlapping functions and activities. The variability in approach and overlapping functions suggest that there is no overall integrated regulatory approach.ConclusionRegulation potentially provides a variety of benefits in terms of maintaining the safety and quality of care by providing an external perspective on the care being delivered. However, the variability, extent and fragmentation of the regulatory system of the NHS make it hard for regulators to act effectively and places a massive burden on NHS provider organisations. Overlapping regulatory requests may distract locally driven initiatives to improve safety and quality. Further research is needed to understand the full extent of regulatory activity and the true benefits and costs incurred.

Background Despite an emerging consensus on the importance of resilience as a framework for understanding the healthcare system, the operationalization of resilience in healthcare has become an area of continuous discussion, and especially so when seeking operationalization across different healthcare contexts and healthcare levels. Different indicators for resilience in healthcare have been proposed by different researchers, where some indicators are coincident, some complementary, and some diverging. The overall aim of this article is to contribute to this discussion by synthesizing knowledge and experiences from studies in different healthcare contexts and levels to provide holistic understanding of capacities for resilience in healthcare. Methods This study is a part of the first exploratory phase of the Resilience in Healthcare programme. The exploratory phase has focused on screening, synthesising, and validating results from existing empirical projects covering a variety of healthcare settings. We selected the sample from several former and ongoing research projects across different contexts and levels, involving researchers from SHARE, the Centre for Resilience in Healthcare in Norway. From the included projects, 16 researchers participated in semi-structured interviews. The dataset was analysed in accordance with grounded theory. Results Ten different capacities for resilience in healthcare emerged from the dataset, presented here according to those with the most identified instances to those with the least: Structure, Learning, Alignment, Coordination, Leadership, Risk awareness, Involvement, Competence, Facilitators and Communication. All resilience capacities are interdependent, so effort should not be directed at achieving success according to improving just a single capacity but rather at being equally aware of the importance and interrelatedness of all the resilience in healthcare capacities. Conclusions A conceptual framework where the 10 different resilience capacities are presented in terms of contextualisation and collaboration was developed. The framework provides the understanding that all resilience capacities are associated with contextualization, or collaboration, or both, and thereby contributes to theorization and guidance for tailoring, making operationalization efforts for the identified resilience capacities in knowledge translation. This study therefore contributes with key insight for intervention development which is currently lacking in the literature.

Background Adaptation and innovation are both described as instrumental for resilience in healthcare. However, the relatedness between these dimensions of resilience in healthcare has not yet been studied. This study seeks to develop a conceptual understanding of adaptation and innovation as a basis for resilience in healthcare. The overall aim of this study is therefore to explore how adaptation and innovation can be described and understood across different healthcare settings. To this end, the overall aim will be investigated by identifying what constitutes adaptation and innovation in healthcare, the mechanisms involved, and what type of responses adaptation and innovation are associated with. Methods The method used to develop understanding across a variety of healthcare contexts, was to first conduct a narrative inquiry of a comprehensive dataset from various empirical settings (e.g., maternity, transitional care, telecare), that were later analysed in accordance with grounded theory. Narrative inquiry provided a contextually informed synthesis of the phenomenon, while the use of grounded theory methodology allowed for cross-contextual comparison of adaptation and innovation in terms of resilience in healthcare. Results The results identified an imbalance between adaptation and innovation. If short-term adaptations are used too extensively, they may mask system deficiencies and furthermore leave the organization vulnerable, by relying too much on the efforts of a few individuals. Hence, short-term adaptations may end up a barrier for resilience in healthcare. Long-term adaptations and innovation of products, processes and practices proved to be of a lower priority, but had the potential of addressing the flaws of the system by proactively re-organizing and re-designing routines and practices. Conclusions This study develops a new conceptual account of adaptation and innovation as a basis for resilience in healthcare. Findings emerging from this study indicate that a balance between adaptation and innovation should be sought when seeking resilience in healthcare. Adaptations can furthermore be divided into short-term and long-term adaptations, creating the need to balance between these different types of adaptations. Short-term adaptations that adopt the pattern of firefighting can risk generating complex and unintended outcomes, but where no significant changes are made to organization of the system. Long-term adaptations, on the other hand, introduce re-organization of the system based on feedback, and therefore can provide a proactive response to system deficiencies. We propose a pattern of adaptation in resilience in healthcare: from short-term adjustments, to long-term reorganizations, to innovations.

Background Every safety-critical industry devotes considerable time and resource to investigating and analysing accidents, incidents and near misses. The systematic analysis of incidents has greatly expanded our understanding of both the causes and prevention of harm. These methods have been widely employed in healthcare over the last 20 years but are now subject to critique and reassessment. In this paper, we reconsider the purpose and value of incident analysis and methods appropriate to the healthcare of today. Main text The primary need for a revised vision of incident analysis is that healthcare itself is changing dramatically. People are living longer, often with multiple co-morbidities which are managed over very long timescales. Our vision of safety analysis needs to expand concomitantly to embrace much longer timescales. Rather than think only in terms of the prevention of specific incidents, we need to consider the balance of benefit, harm and risks over long time periods encompassing the social and psychological impact of healthcare as well as physical effects. We argued for major changes in our approach to the analysis of safety events: assume that patients and families will be partners in investigation and where possible engage them fully from the beginning, examine much longer time periods and assess contributory factors at different time points in the patient journey, be more proportionate and strategic in analysing safety issues, seek to understand success and recovery as well as failure, consider the workability of clinical processes as well as deviations from them and develop a much more structured and wide-ranging approach to recommendations. Conclusions Previous methods of incident analysis were simply adopted and disseminated with little research into the concepts, methods, reliability and outcomes of such analyses. There is a need for significant research and investment in the development of new methods. These changes are profound and will require major adjustments in both practical and cultural terms and research to explore and evaluate the most effective approaches.