What is Resilient Health Care?
Resilient Health Care (RHC) offers an alternative understanding of how we may approach the wicked problem of improvement in health care. RHC brings together the understanding of resilience engineering with health care. At the core it challenges us to develop a much clearer understanding of the real world of health care and the work required within it. That is “Work as Done” rather than “Work as Imagined”.
A new way of thinking about healthcare
Health Care systems have characteristically been organised along hierarchical lines, inviting management and workers to function within it in a traditional “dance”. Governments and payers determine policy, which is then enacted by management and carried out by the workforce.
RHC questions this orthodoxy and promotes an understanding of Health Care as a Complex Adaptive System (CAS). CASs are characterized by self-organisation and emergent behaviours. Perhaps this could be described as the workers getting on and delivering health care, regardless of the intent, aspirations and directions of management and policy makers.
The new way of thinking about patient safety allows us to “engineer-in” resilience within a complex and adaptive system, that is the capacity to “get it right” despite things going wrong along the way, rather than the traditional approach to “engineer-out” risk.
RHC challenges our understanding of hierarchical management structures and operational models, and introduces some paradigm shifts into the way we view risk and safety, and allows us to identify and recognise the importance of context, flexibility, and complexity that we have (perhaps subversively) considered and responded to over the years, without the framework to fully understand why some things work and others don’t.
The international Resilient Health Care Society has been advancing this construct for over ten years and members have published widely on the subject.