Resilience in healthcare and clinical handover

Abstract

BACKGROUND: Understanding and applying human factors in healthcare provides significant opportunities for improving patient safety. A key human factors concept is "resilience," which investigates how individuals, teams and organisations monitor, adapt to and act on failures in high-risk situations. Although it is a new concept to healthcare, it is well accepted in other high-risk industries. Resilience moves the focus away from "What went wrong?" to "Why does it go right?", that is, it moves from simplistic reactions to error making toward valuing a proactive focus on error recovery. Resilience is a better match for healthcare settings than the principles for high reliability because it more effectively addresses the unique complexities of healthcare. OBJECTIVE: This article introduces the concept of resilience and how it applies to healthcare using clinical handover as an exemplar. Clinical handover and the risks it presents to patient safety are used to illustrate the key principles of resilience to healthcare professionals. The overall aim of this paper is to motivate research which focuses on understanding how frontline staff "fix" mistakes. Researching resilience in healthcare needs to focus on developing measurement, improvement and prediction tools. CONCLUSION: Resilience can benefit patient safety efforts because it represents a change in emphasis from a traditional, reactive focus on errors to seeing humans as a defence against failure. Translating this concept into practice requires identifying and testing mechanisms for measuring and building resilience within complex healthcare processes.

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