All entries for Thursday 23 November 2017

November 23, 2017

New (Safety–II) directions for organisational learning in healthcare

I am currently writing a commentary for International Journal of Health Policy & Management on Russel Mannion and Jeffrey Braithwaite's editorial "False Dawns and New Horizons in Patient Safety Research and Practice" (1). Russel and Jeffrey provide an insightful critique of traditional patient safety improvement efforts, and provide a powerful alternative vision based on Safety-II thinking.

In my commentary I apply the Safety-II perspective to organisational learning in healthcare organisations. My key argument is that healthcare organisations have been struggling to learn from experience, because they are concerned only with incidents and adverse events - the extraordinary catastrophe (2). What these approaches fail to appreciate is the role of performance variability and the manifold adaptations by healthcare workers who prevent daily disruptions and tension from turning into daily disasters (3). In my opinion organisational learning should be concerned just as much with the ordinary everday clincal work (work-as-done) as with the extraordinary failures (4,5). A corollary that follows from this is that organisational learning should be democratic and encompas frontline communities of practice, rather than being the remit of a central risk management facility (6).

References:

[1] Mannion, R. and Braithwaite, J., 2017. False dawns and new horizons in patient safety research and practice. International Journal of Health Policy and Management.

[2] Sujan, M.A., Pozzi, S. and Valbonesi, C., 2016. Reporting and learning: from extraordinary to ordinary. Resilient Health Care, Volume 3: Reconciling Work-as-Imagined and Work-as-Done, p.103.

[3] Sujan, M., Spurgeon, P. and Cooke, M., 2015. The role of dynamic trade-offs in creating safety—A qualitative study of handover across care boundaries in emergency care. Reliability Engineering & System Safety, 141, pp.54-62.

[4] Sujan, M.A., Huang, H. and Braithwaite, J., 2016. Learning from incidents in health care: Critique from a Safety-II perspective. Safety Science, 99, pp115-121.

[5] Sujan, M. and Furniss, D., 2015. Organisational reporting and learning systems: Innovating inside and outside of the box. Clinical Risk, 21(1), pp.7-12.

[6] Sujan, M., 2015. An organisation without a memory: a qualitative study of hospital staff perceptions on reporting and organisational learning for patient safety. Reliability Engineering & System Safety, 144, pp.45-52.