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Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC.
Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a thematic approach.
Results Thirty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups and surveys) and indirect (e.g. observations and simulations) data sources. Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC.
Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.
Keywords
health care, resilience, Resilient Health Care, Safety-II, Work As Done, assessment methods, safety
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CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 4
Posted 13 Apr, 2020
No community comments so far
Submission checks complete
On 10 Apr, 2020
Editorial decision: Accept
On 09 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 03 Apr, 2020
Editor assigned
On 02 Apr, 2020
Submission checks complete
On 01 Apr, 2020
Editor invited
On 01 Apr, 2020
Community comments: 1
Editorial decision: Minor revision
On 29 Feb, 2020
Review #1 received
Received 06 Feb, 2020
Reviewers invited
Invitations sent on 31 Jan, 2020
Reviewer #1 agreed
On 31 Jan, 2020
Editor assigned
On 20 Jan, 2020
Submission checks complete
On 19 Jan, 2020
Editor invited
On 19 Jan, 2020
No comments provided
Editorial decision: Major revision
On 02 Dec, 2019
Review #1 received
Received 01 Dec, 2019
Review #2 received
Received 13 Nov, 2019
Reviewer #2 agreed
On 12 Nov, 2019
Reviewers invited
Invitations sent on 08 Nov, 2019
Reviewer #1 agreed
On 08 Nov, 2019
Editor assigned
On 14 Oct, 2019
Submission checks complete
On 13 Oct, 2019
Editor invited
On 13 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
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See the published version of this preprint at BMC Health Services Research.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Health Services Research.
Version 4
Posted 13 Apr, 2020
No community comments so far
Submission checks complete
On 10 Apr, 2020
Editorial decision: Accept
On 09 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 03 Apr, 2020
Editor assigned
On 02 Apr, 2020
Submission checks complete
On 01 Apr, 2020
Editor invited
On 01 Apr, 2020
Community comments: 1
Editorial decision: Minor revision
On 29 Feb, 2020
Review #1 received
Received 06 Feb, 2020
Reviewers invited
Invitations sent on 31 Jan, 2020
Reviewer #1 agreed
On 31 Jan, 2020
Editor assigned
On 20 Jan, 2020
Submission checks complete
On 19 Jan, 2020
Editor invited
On 19 Jan, 2020
No comments provided
Editorial decision: Major revision
On 02 Dec, 2019
Review #1 received
Received 01 Dec, 2019
Review #2 received
Received 13 Nov, 2019
Reviewer #2 agreed
On 12 Nov, 2019
Reviewers invited
Invitations sent on 08 Nov, 2019
Reviewer #1 agreed
On 08 Nov, 2019
Editor assigned
On 14 Oct, 2019
Submission checks complete
On 13 Oct, 2019
Editor invited
On 13 Oct, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Health Economics & Outcomes Research
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Health Services Research.
Background Traditional approaches to safety management in health care have focused primarily on counting errors and understanding how things go wrong. Resilient Health Care (RHC) provides an alternative complementary perspective of learning from incidents and understanding how, most of the time, work is safe. The aim of this review was to identify how RHC is conceptualised, described and interpreted in the published literature, to describe the methods used to study RHC, and to identify factors that develop RHC.
Methods Electronic searches of PubMed, Scopus and Cochrane databases were performed to identify relevant peer-reviewed studies, and a hand search undertaken for studies published in books that explained how RHC as a concept has been interpreted, what methods have been used to study it, and what factors have been important to its development. Studies were evaluated independently by two researchers. Data was synthesised using a thematic approach.
Results Thirty-six studies were included; they shared similar descriptions of RHC which was the ability to adjust its functioning prior to, during, or following events and thereby sustain required operations under both expected and unexpected conditions. Qualitative methods were mainly used to study RHC. Two types of data sources have been used: direct (e.g. focus groups and surveys) and indirect (e.g. observations and simulations) data sources. Most of the tools for studying RHC were developed based on predefined resilient constructs and have been categorised into three categories: performance variability and Work As Done, cornerstone capabilities for resilience, and integration with other safety management paradigms. Tools for studying RHC currently exist but have yet to be fully implemented. Effective team relationships, trade-offs and health care ‘resilience’ training of health care professionals were factors used to develop RHC.
Conclusions Although there was consistency in the conceptualisation of RHC, methods used to study and the factors used to develop it, several questions remain to be answered before a gold standard strategy for studying RHC can confidently be identified. These include operationalising RHC assessment methods in multi-level and diverse settings and developing, testing and evaluating interventions to address the wider safety implications of RHC amidst organisational and institutional change.
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