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Resilient Health Care

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Table of Contents

Contents: Preface, Robert L. Wears, Erik Hollnagel and Jeffrey Braithwaite; A lesson in resilience: the 2011 Stanley Cup riot, Garth S. Hunte; Translating tensions into safe practices through dynamic trade-offs: the secret second handover, Mark A. Sujan, Peter Spurgeon and Matthew W. Cooke; Workarounds in nursing practice in acute care: a case of a health care arms race?, Deborah Debono and Jeffrey Braithwaite; The demands imposed by a health care reform on clinical work in transitional care of the elderly: a multi-faceted Janus, Kristin Laugaland and Karina Aase; The Stockholm blizzard of 2012, Mirjam Ekstedt and Richard I. Cook; Individual-collective trade-offs: implications for resilience, Robert L. Wears, Christiane C. Schubert and Garth S. Hunte; Managing medicines management: organisational resilience in community pharmacies, Denham Phipps, Darren Ashcroft and Dianne Parker; Blood transfusion with health information technology in emergency settings from a Safety-II perspective, Kazue Nakajima; Exposing hidden aspects of resilience and brittleness in everyday clinical practice using network theories, Jeffrey Braithwaite and Jennifer Plumb; Patient boarding in the emergency department as a symptom of complexity-induced risks, Robert J. Stephens, David D. Woods and Emily S. Patterson; Looking for patterns in everyday clinical work, Erik Hollnagel; Tempest in a teapot: standardisation and workarounds in everyday clinical work, Shawna J. Perry and Rollin J. Fairbanks; ECW in complex adaptive systems, Rob Robson; Revealing resilience through critical incident narratives: a way to move from Safety-I to Safety-II, Sam Sheps, Karen Cardiff, Elaine Pelletier and Rob Robson; Patients as a source of resilience, Christiane C. Schubert, Robert L. Wears, Richard J. Holden and Garth S. Hunte; Strategies to get resilience into everyday clinical work, Sheuwen Chuang and Robert L. Wears; Mobilising resilience by monitoring the right things for the right people at the right time, Al Ross and Janet E. Anderson; Why is work-as-imagined different from work-as-done?, Erik Hollnagel; Bibliography; Index.

About the Author

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 Linkoping (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, 2012), Governance and control of financial systems (Ashgate, 2011), Resilience Engineering in practice (Ashgate, 2011), The ETTO Principle (Ashgate, 2009). Erik is also Editor-in-chief of Ashgate Studies in Resilience Engineering. Jeffrey Braithwaite, BA, DLR, MIR (Hons), MBA, PhD, FACHSM, FAIM, FFPHRCP (UK) is Professor of Health Systems Research and Foundation Director of the Australian Institute of Health Innovation at Macquarie University, Sydney, Australia. He is Visiting Professor at University of Birmingham, UK, Adjunct Professor of Resilient Health Care and Patient Safety, University of Southern Denmark, and Senior International Fellow at the Canon Institute for Global Studies in Tokyo, Japan. His work investigates and contributes to systems improvement. His expertise is in empiricising and theorising about health systems including researching the culture and structure of acute settings, leadership, management and change in health sector organisations, quality and safety in health care, accreditation and surveying processes in international context and the restructuring of health services. Professor Braithwaite has published more than 300 refereed contributions, and 500 total publications and he has presented at or chaired international and national conferences, workshops, symposia and meetings on more than 500 occasions, including over 60 keynote addresses. Professor Braithwaite is the recipient as at 2014 of career research funding of US$60 million spread over 60 grants. He referees for 30 journals and the health research bodies including in Ireland, New Zealand, Switzerland and the United Kingdom.


'Those heading health systems and seeking to make them safer need to spend more time upstream, thinking about how to make their organisations truly resilient. This important new book walks them up the river bank.' Sir Liam Donaldson, Imperial College London, UK 'An original, important and timely volume that applies the emerging discipline of resilience engineering to the design and improvement of healthcare systems. What makes the book so engrossing is the way it blends captivating stories (e.g. blizzards, riots) with the insights extracted from them.' Gary Klein, author of Sources of Power: How People Make Decisions 'Anyone who is responsible for patient safety needs to understand resilience engineering, especially how people actually get their work done, which is not how those who design and manage the work expect it is being done. Resilient Health Care, Volume 2: The Resilience of Everyday Clinical Work offers understanding for managers and safety professionals about why we haven't yet made healthcare neither acceptably safe nor productive. If reliance engineering was applied more in healthcare, fewer patients would suffer and our healthcare system would get more value from the vast sums of money spent.' Jeffrey B. Cooper, PhD, Harvard Medical School, USA 'Here is a must-have book on resilience through the eyes of a unique team: the pioneer, the researcher, and the practitioner. The term "resilience" has entered general linguistic use and this broad use may also leave everything vague. This second book on healthcare resilience, written by the team of the pioneer (Erik), the researcher (Jeffrey) and the practitioner (Bob) sets the record straight. It reverses usual ways to debate resilience via only theories and concepts, starts from the real world, shows every-day resilience in healthcare, listens to professionals and draws out general lessons. Some examples are closely related to clinical care, others are more about management; all are an incredible source of creative inspiration for our own medical environments. A book that should be read and re-read by healthcare professionals.' Rene Amalberti, Haute Authorite de sante (HAS), France Comments on the first volume: 'This book turns patient safety on its head, and in the process shines the spotlight on the need for intelligence, flexibility, adaptability, and responsiveness of front line staff as the key to safer care. Instead of the current (what the authors dub "Safety I") paradigm, the authors, including many of the leading thinkers in patient safety research, develop a new "Safety II" approach designed for today's dynamic and complex health systems.' Gordon Schiff MD, Associate Director, Center for Patient Safety Research and Practice, Brigham and Women's Hospital and Associate Professor of Medicine Harvard Medical School, USA 'Inspiring! Resilient Health Care evokes a sort of enlightenment about how the healthcare industry might be positively transformed as we take a more proactive approach to patient safety. This rich compilation of safety experts' wisdom regarding the application of resilience engineering principles in healthcare practice is the perfect spring board for developing tools to improve patient safety and the patient experience. Healthcare leaders everywhere need to hear the message this book conveys!' Sheila Bosch, Director of Research, Gresham, Smith and Partners 'The book Resilient Health Care is important for everyone who is looking for a new perspective on how to improve care for patients in complex organisations. For years, we have focused on evidence based guidelines, quality management and accreditation with extensive procedures and regulations to reduce incidents. Now it is time to balance back, look for things going right instead of wrong, and enforce knowledge and teamwork at the work floor.' Cordula Wagner, VU Amsterdam, The Netherlands

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