The Resilient Health Care Net

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Objective
The purpose of the Resilient Health Care Initiative (RHCN) is to facilitate the interaction and collaboration among people who are interested in applying Resilience Engineering to health care – practitioners and researchers alike. This includes, but is not limited to, discussions (face-to-face, skype, or via other media); establishing a web presence; exchange of views, opinions, and ideas; mutual moral and scientific support; collaboration on papers and projects; exchange visits; and the organisation of various events ranging from local informal workshops to international summer schools.

Background
The developments in safety thinking, in health care and elsewhere, can briefly be characterised by looking at two different interpretations of safety, called Safety I and Safety II, respectively.

• According to Safety I, a system is safe if there are no accidents or incidents. That can be achieved, for instance, by ‘avoiding injuries or harm to patients from care that is intended to help them’ (US AHRQ). The purpose of investigations and management in Safety I is therefore to make sure that as little as possible goes wrong.

• According to Safety II, a system is safe if it can ‘adjust its functioning prior to, during, or following changes and disturbances, so that it can sustain required operations under both expected and unexpected conditions,’ i.e., if it is resilient. The purpose of safety related activities is therefore to make sure that as much as possible goes right.

The goals of Safety I and Safety II are in a way the same, namely that there are as few adverse events as possible. But whereas Safety I tries to achieve this by eliminating what can go wrong, Safety II tries to achieve it by facilitating everyday work, by improving its resilience and thereby ensure that as much as possible goes right. Another way of saying that is that Safety-I tries to get away from something, namely an unsafe state, while Safety-II tries to approach something, namely a safe state. When you try to get away from something, almost any direction will do. But if you try to approach something, only one direction will bring you closer.
A more detailed discussion of the background can be found here.

Scope
It follows from the description of Safety II that the scope exceeds the traditional safety topics and concerns. The focus is not limited to what goes wrong, but includes what goes right. The focus is not just failures and cause-effect relations but everyday work and the functioning of the health care system as a whole. This means that all aspects of everyday work, as well as all that affects it, must be considered – from safety, productivity and quality to planning, policy, and politics. One good reason for that is that health care consumes a large part of a country’s economy. In 2008, the health care industry consumed an average of 9.0 percent of the gross domestic product (GDP) across the most developed OECD countries. The United States (16.0%), France (11.2%), and Switzerland (10.7%) were the top three spenders.

Ambition
The ambition of the RHCN is to take a lead in applying resilience engineering to health care worldwide; to become a generally recognised source of expertise, academically as well as practically; and to become an incubator for ideas and methods that can improve the resilience of health care on all levels.

Tentative plans
The needs, interests, and energy of the participants in the initiative will determine which concrete activities will be undertaken. The following suggestions can serve as a starting point:

• Meetings, regional, national, and international.

• Exchange visits.

• Specialised courses and summer schools.

• Joint research and development projects.

• On-line discussion forums to define and develop central themes for RHCN.

Who is behind this?
The RHCN constitutes one of the activities in the Patient Safety Agenda of the Region of Southern Denmark. This partnership includes the hospitals in the Region of Southern Denmark, the Centre for Quality Improvement, the Faculty of Health Sciences and the Faculty of Social Sciences at the University of Southern Denmark.
The start-up of the RHCN is managed by a Core Group.

What is in it for you?
As stated in the objectives, the purpose of this initiative is to try to make use of the resilience engineering principles in health care – and specifically to try to move from Safety I to Safety II. If you are interested in finding out more about what this entails, or even in helping to do that, you are encouraged to join the initiative. If you do so, we expect that you will not only follow what is going on but also take actively part. Your experience and your motivation will be important in determining how the RHCN is going to develop. In return you will have the opportunity to meet and interact with people who share your concerns, and to use as much time and energy as you want to engage in concrete activities.
What should you do if you want to become part of this?
If you are interested in becoming part of the RHCN, please contact .
If you want to learn more before deciding whether or not to join, feel free to send a mail Erik Hollnagel or any of the members of the RHCN Core Group.
If you think someone else might be interested in hearing about the RHCN, please pass on this invitation.

About the logo
The first part of the logo is a kanji that has been proposed to represent ‘resilience.’ It can be interpreted as ‘bouncing back’ or ‘ soft, and recoverable rapidly.’ The second part of the logo is, of course, the Rod of Asclepius, which represents medicine and healing.