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Background To reduce patient harm, healthcare has focused on improvement based on learning from errors and adverse events (Safety-I). Daily huddles with staff are used to support incident reporting and learning in healthcare. It is proposed that learning for improvement should also be based on situations where work goes well (Safety-II); daily safety huddles should also reflect this approach. A Safety-II-inspired model for safety huddles was developed and implemented at the Neonatal Care Unit at a regional hospital in Sweden. This study followed the implementation with the research questions: Do patient safety huddles with a focus on Safety-II affect the results of measurements of the patient safety culture? What are the experiences of these huddles amongst staff? What experiences of everyday work arise in the patient safety huddles? Methods A multi-method approach was used. The quantitative part consisted of a questionnaire (151 items), submitted on four different occasions, and analysed using Mann Whitney U-test and Kruskal Wallis ANOVA-test. The qualitative data were analysed using thematic content analyses of interviews with staff (n = 14), as well as answers to open questions in the questionnaires. Results There were 151 individual responses to the questionnaires. The response rates were 44% to 59%. For most comparisons, there were no differences. There were minor changes in patient safety culture measurements. A lower rating was found in December 2020, compared to October 2019 (p Conclusions For patient safety huddles aimed at exploring everyday work to be experienced as a base for learning, including both negative and positive events (Safety-II); there is a need for an open and permissive climate, that all professions participate and stable conditions in management. Support from managers and knowledge of the underpinning Safety-II theories of those who lead the huddles, may also be of importance.

Background Traditional safety concept, which is called Safety-I, and its relevant methods and models have much contributed toward enhancing the safety of industrial systems. However, they have proved insufficient to be applied to complex socio-technical systems. As an alternative, Safety-II and resilience engineering have emerged and gained much attention for the last two decades. However, it seems that safety professionals have still difficulty understanding their fundamental concepts and methods. Accordingly, it is necessary to offer an introductory guide to them that helps safety professionals grasp them correctly in consideration of their current practices. Methods This article firstly explains the limitations of Safety-I and how Safety-II can resolve them from the four points of view. Next, the core concepts of resilience engineering and Functional Resonance Analysis Method are described. Results Workers' performance adjustment and performance variability due to it should be the basis for understanding human-related accidents in socio-technical systems. It should be acknowledged that successful and failed work performance have the same causes. However, they are not well considered in the traditional safety concept; in contrast, Safety-II and resilience engineering have conceptual bases and practical approaches to reflect them systematically. Conclusion It is necessary to move from a find-and-fix and reactive approach to a proactive approach to safety management. Safety-II and resilience engineering give a set of useful concepts and methods for proactive safety management. However, if necessary, Safety-I methods need to be properly used for situations where they can still be useful as well.

Aviation is the fastest growing but also the safest mode of transport. International aviation organizations give the highest priority to safety while creating aviation regulations. Therefore, a safety management system (SMS) has been created. Two approaches to assuring safety in aviation may be distinguished: Safety-I and Safety-II. Safety-I is the standard approach, focused on processing the information about malfunctioning features and system elements. On the other hand, Safety-II is a new approach to safety management, based on identifying the elements or functions of the system that work properly, which enables the system to confirm resilience to undesirable effects. One of the methods utilized for the Safety-II approach in order to study complex sociotechnical systems is the FRAM (functional resonance analysis method). The method is focused on analysing daily activities in various conditions in order to create a model of work performance. The models created based on the FRAM can be used for risk analysis, accident investigations and predicting possible future events affecting aviation safety. This method allows us to simulate system constraints and uncertain states. It can also be used as support for the air traffic safety management processes based on the Safety-II approach. The following article presents a developed FRAM model for the transfer of control over aircraft. This model constitutes an example of a coordination scheme limited to basic activities of air traffic control (ATC) services, providing a general framework for the construction and operation of the FRAM model.

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.

The use of non-linear models to understand complex processes in healthcare is not a fully adopted concept. Current patient safety research focuses on events by studying adverse events, typically trying to understand the root causes of failures. This article describes an attempt in a Danish hospital to create an understanding of how complex processes produce positive outcomes despite variability and unforeseen factors, using the functional resonance analysis method (FRAM) to describe a frequent activity in healthcare: early detection of sepsis. The model presents 40 activities performed by nurses, doctors, secretaries, health workers and laboratory technicians; and illustrates possible and actual variability in the process. The results reveal that the application of FRAM helped to gain a heightened understanding of a complex healthcare process. The FRAM provided new insights to staff by focusing on aspects that previously had not been central when working with the patient safety during sepsis detection. This included aspects such as becoming aware of the importance of asking the right questions during the referral process from a general practitioner, using experience and clinical judgement during early assessment of patients and the importance of having a good collegial relationship between doctors and nurses. The method helped reveal how the process is often able to succeed despite variability, and how aspects like experience and clinical judgement play a vital role in adapting to everyday conditions. This knowledge can enhance the understanding of how complex processes develop and be useful in supporting their management and improving patient safety.

Modern trends of socio-technical systems analysis suggest the development of an integrated view on technological, human and organizational system components. The Air Traffic Management (ATM) system can be taken as an example of one of the most critical socio-technical system, deserving particular attention in managing operational risks and safety. In the ATM system environment, the traditional techniques of risk and safety assessment may become ineffective as they miss in identifying the interactions and couplings between the various functional aspects of the system itself: going over the technical analysis, it is necessary to consider the influences between human factors and organizational structure both in everyday work and in abnormal situations. One of the newly introduced methods for understanding these relations is the Functional Resonance Analysis Method (FRAM) which aims to define the couplings among functions in a dynamic way. This paper evolves the traditional FRAM, proposing an innovative semi-quantitative framework based on Monte Carlo simulation. Highlighting critical functions and critical links between functions, this contribution aims to facilitate the safety analysis, taking account of the system response to different operating conditions and different risk state. The paper presents a walk-through section with a general application to an ATM process.

In contrast to the conventional safety management principle, namely, safety-I, which focuses on “what goes wrong”, a new-born safety philosophy (safety-II) inspires people to investigate “how and why things go right”. In the present study, the cognitive difference and correlation between safety-I and safety-II in the maritime shipping industry are explored and investigated. For this purpose, a questionnaire is administered to survey seafarers and maritime experts, and semi-structured interviews are conducted to collect original data associated with safety-I and safety-II. Then, the data from seafarers and maritime experts are further processed by empirical statistical methods and fuzzy analytic hierarchy process (AHP) methodology. The results show that impacting factors associated with individual aspects are usually accepted as dominant with respect to views of safety-I, while organizational factors are more influential for safety-II, which is essential to developing an organizational resilience capacity. Based on the findings and discussions, potential safety countermeasures that integrate safety-I and safety-II are proposed in this article. The present study discusses the new-born safety-II perspective to elucidate the safety issues associated with maritime shipping operations, which can be seen as the main innovation of this work.

Así mismo, los resultados reflejan la necesidad de mejora de la cultura preventiva en todos los niveles y del uso de los planes de seguridad y salud como elemento facilitador de la gestión seguridad en las obras. En base a ello, se propone un instrumento de evaluación de la gestión resiliente de la seguridad en las obras. Las conclusiones de esta investigación revelan el potencial que presenta el FRAM para proporcionar una perspectiva diferente del desempeño organizacional y la importancia de fomentar el desarrollo de las habilidades necesarias para el desempeño resiliente con la ayuda de herramientas como el instrumento de evaluación propuesto basado en el RAG. Se encontraron como principales barreras para la aplicación de la Ingeniería de la Resiliencia en el sector de la construcción la resistencia al cambio, la concentración de diferentes organizaciones en la obra, las presiones económicas y el marco legal actual. La investigación desarrollada es aplicable de forma directa a las obras de construcción y se espera que contribuya a la mejora significativa de la gestión de la seguridad en las obras de construcción desde un enfoque proactivo. Fecha de lectura Tesis Doctoral: 14 Diciembre 2018. La mejora de la gestión de seguridad en el sector de la construcción continúa siendo una necesidad dada la elevada siniestralidad del sector. Tradicionalmente, esta gestión se ha basado en modelos de causalidad lineales simples o complejos que no se adaptan a la realidad actual de las organizaciones cada vez más complejas y acopladas. Así, surgen los modelos sistémicos y con ellos la Ingeniería de la Resiliencia como un nuevo paradigma de la gestión de la seguridad centrado en cómo ayudar a las personas a lidiar con la complejidad bajo presión para lograr el éxito. Hasta ahora los estudios en el sector de la construcción con este nuevo paradigma son escasos. El objetivo general de la tesis es estudiar las actividades de construcción desde el prisma de la Ingeniería de la Resiliencia para mejorar la gestión y el seguimiento de la seguridad en dichas actividades. De él se derivan dos objetivos principales centrados en modelar y analizar los trabajos de ejecución de estructuras en edificios conforme a la Ingeniería de la Resiliencia y diseñar y validar un instrumento de evaluación de la resiliencia en la gestión de la seguridad de las actividades de construcción para facilitar la mejora y seguimiento del desempeño. Las metodologías empleadas para ello fueron de carácter cualitativo. Concretamente, para el modelado y análisis se usó el Functional Resonance Analysis Method (FRAM) y el Leading Indicator Identification Method. En el diseño del instrumento de evaluación se empleó el Resilience Assesment Grid (RAG) y para su validación se realizaron diferentes paneles de expertos basados en el Método de Agregados Individuales y el Método Delphi. Los resultados de este estudio destacan la importancia de diversas actividades por su impacto en la variabilidad y por ende en la gestión resiliente.

The current approach to patient safety, labelled Safety-I, is predicated on a 'find and fix' model. It identifies things going wrong, after the event, and aims to stamp them out, in order to ensure that the number of errors is as low as possible. Healthcare is much more complex than such a linear model suggests. We need to switch the focus to what we have come to call Safety-II: a concerted effort to enable things to go right more often. The key is to appreciate that healthcare is resilient to a large extent, and everyday performance succeeds much more often than it fails. Clinicians constantly adjust what they do to match the conditions. Facilitating work flexibility, and actively trying to increase the capacity of clinicians to deliver more care more effectively, is key to this new paradigm. At its heart, proactive safety management focuses on how everyday performance usually succeeds rather than on why it occasionally fails, and actively strives to improve the former rather than simply preventing the latter.

Master's thesis in Risk management Thousands of Norwegian patients experience serious injury and death every year due to preventable adverse events. Risk management in healthcare is a relatively new discipline. Methods from other high-risk sectors, for instance aerospace, have been adopted without sufficient success. Healthcare consists of highly complex sociotechnical systems and thus differs from other high-risk sectors. Existing risk and safety management methods should be supplied with new approaches to prevent patient harm. This thesis is an attempt to contribute to the development of a leading risk indicator framework by proposing some fundamental characteristics. Leading indicators can monitor real-time changes in risk related to patient harm. Adjustments to the activities based on information about changes in the risk picture can prevent adverse events and maximize patient safety. This view of safety is in accordance with the concept of Safety-II. The principle is to anticipate rather than experience hazards, and adapt to situations rather than respond to unwanted events. Leading risk indicators that change before the risk level changes provide the opportunity to make adjustments before adverse events occur. That is a condition for indicators to be categorized as leading. The System-Theoretic Accident Model and Processes (STAMP) identifies leading indicators by assessing the vulnerability of safety-critical assumptions . In order to reduce heuristic biases, the vulnerability assessment is related to the plausibility and severity potential of a hazard. Safety-critical assumptions include barriers, as well as other risk and safety influencing factors. The majority of barriers in healthcare are procedural, and human factors are important barrier influencing factors. The presence of human factors is influenced by the safety culture of an organization. The safety culture includes the attitude, awareness and approach to safety of personnel at all levels. Approaches and methods from other high-risk sectors have been reviewed. The thesis concludes that elements from approaches and methods may be combined as a basis for further development of an appropriate leading risk indicator framework. The thesis also concludes that the use of Bayes Nets provides a powerful modeling tool of leading risk indicator systems. Certain elements of a leading risk indicator model are suggested.

This review analyses the contributions about resilience engineering as an emerging topic in healthcare literature. Owing to the cross-disciplinarity of the theme, this review takes into account PubMed and Scopus databases through March 2017 as well as other not-indexed papers from the Resilience Engineering Association (REA) symposia and other books in the field. After removing duplicates and screening full-texts, we analysed 63 studies that were categorised into four groups that describe the current research state of resilience engineering in healthcare. This scoping review demonstrates the relevance of resilience in complex healthcare activities, exploring the potential benefits to engineer it. The theoretical background and the preliminary applications confirm the potential of this paradigm shift for safety management to cope with current and future healthcare system needs.

This paper illustrates the challenges of safety management in Academia, which are difficult to overcome using conventional methods of risk management. The positive aspects and disadvantages of the risk management tools specifically designed for the laboratory collection are addressed. We propose a different approach to hazard detection that can ease the burden for Academia safety experts of tedious time-consuming risk assessment. Based on the observations of Academia’s safety management, we are attempting to build a semi-quantitative risk analysis model that will conform to the concept of safety-II. This paper suggests an approach that allows to integrate this model into human oriented performance driven decision making.