Minding the Gaps: Creating Resilience in Health Care

Resilience is the intrinsic ability of a system to adjust its functioning prior to, during, or following changes and disturbances so that it can sustain required operations, even after a major mishap or in the presence of continuous stress. As an emergent property of systems that is not tied to tallies of adverse events or estimates of their probability, resilience provides the means for organizations to target resource investments by integrating safety and productivity concerns. Resilience engineering (RE) can enable an organization to cope with and recover from unexpected developments, such as maintaining the ability to adapt when demands go beyond an organization’s customary operating boundary. Understanding resilience makes the difference between organizations that inadvertently create complexity and miss signals that risks are increasing, and those that can manage high-hazard processes well. We discuss two examples of resilience: the response of an emergency department staff to surges in patient volume and design improvements to the infusion device control/display interface.