A holistic approach is recommended to successfully adopt and apply modern safety thinking in healthcare.
- Understanding of safety
- Understanding successes and everyday operations
- Understanding real world practices
- Resilient Healthcare
- Human as a resource
- Understanding variation
Understanding of safety
Safety is when as many things as possible go right.
In Practice:
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Embrace a new safety mindset and stay informed with the latest research advancements.
Understanding successes and everyday operations
Instead of focusing on preventing failures, investigate how health systems succeed in complex and unpredictable situations.
Exploring successes helps us understand 'positive capacities' within the system. Helping build or strengthen positive capacities can help our system go ‘right’ with more reliability.
In Practice:
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Maintain a systems-focused approach to maximise opportunities and organisational learning by exploring the relationships and interactions between people and technologies within the system.
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Ask: 'How can we sustainably embed these positive capacities in our system?'
Understanding real world practices
Recognise the messy realities of getting work done in complex systems. There is almost always a gap between procedures/protocols (Work as Imagined (WAI)) and the actual doing of work in variable conditions (Work as Done (WAD)).
Explore actual workplace practices, adaptations and workarounds that occur, to minimise the gap. Doing so can reduce organisational risk and support safe and effective work.
In Practice:
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Remain humble and curious when exploring real work-as-done. Move beyond judgement towards understanding 'why does it make sense for them to do this that way?'
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Create a safe environment where staff feel empowered to take part in resolving the WAI/WAD gap.
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Listen to staff, they are expert in their work and are likely to understand how to fix issues.
Resilient Healthcare
Not to be confused with psychological resilience, Resilient healthcare is defined as the capacity to adapt to challenges and changes at different system levels, to maintain high-quality care (Wiig, Aase, Billett, et al).
Focus on how successful outcomes are achieved and how to replicate and enhance them.
Resilience can be built by enhancing the capacity of the system, and the individuals within it to adapt to unexpected challenges. These may be large or small.
In Practice:
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Resilient Healthcare is an emerging field that advocates having systems and practices in place that allow a healthcare organisation to quickly adjust to unexpected challenges, across system levels.
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It involves planning, flexibility, and continuous learning to ensure that the system can bounce back and keep functioning well under pressure.
Human as a resource
Humans are key assets in achieving safety, celebrate their adaptability and capacity to manage complex situations.
Empower front-line staff to use their expertise and judgement. Encourage staff to speak up, report near misses, and share innovative solutions.
In Practice:
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Safety is everyone's job. Involve the whole team in conversations about safety.
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Create a safe environment where people are empowered to share their ideas and concerns to tap into this immense resource of knowledge and understanding.
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Provide people 'freedom-in-a-frame to make things go well' (Dekker, S)
Understanding variation
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Understanding variability is crucial to safety.
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Procedures are not foolproof, and systems do not always function as intended.
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Variability is inevitable and sometimes a necessary aspect of work, as staff strive to accomplish tasks under varying conditions, including:
Resource constraints
Workers often have to adapt to limitations in time, equipment, staffing or information. These can lead to variability in how tasks are performed as employees improvise and find workarounds to complete work.
Goal conflicts
Workers often face competing demands such as pressure to complete tasks quickly (efficiency) while also ensuring work is done correctly and safely (thoroughness).
Unpredictable conditions
Factors such as sudden changes in workload, unexpected technical issues, or fluctuating patient needs can introduce variability into how work is carried out. Employees must continuously adjust their actions in response to these changing conditions.
While variability can be undesirable and lead to things going wrong, it can also be an important ingredient in how things go right.
By understanding why variation occurs:
Healthcare organisations can learn from adaptive practices rather than discouraging them. This contributes to a more resilient healthcare system where safety is supported by both adherence to standards and the capacity to adapt when necessary.
Healthcare organisations can understand when variability is the result of staff performing ‘workarounds’ that may reflect systemic barriers to getting work done. This can help reduce potentially unwanted variability that may be creating safety risks.
In Practice:
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It is important to be humble and curious when understanding variation in practice. By asking 'why it made sense for you to do it that way, at that time' we open the door to new opportunities for learning and improvement.
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With these learnings come opportunities to redesign safer systems, at all levels, to help things go right.
