The need of a guide to deliver resilient health care

Erik Hollnagel, Jeffrey Braithwaite

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

2 Citations (Scopus)


Resilient Health Care (RHC), by the time of writing of this chapter, has reached the tender age of six. The developments so far have been summarised in Chapter 1 of this book, and can by now also be found in several other places, e.g., Braithwaite, Wears and Hollnagel (2015). While a comparison with the physiological and psychological development of a child is tempting (but misleading), it is more important to recognise that RHC during its first six years has become widely recognised as a viable supplement – and perhaps even a viable alternative – to the established approaches to safety in hospitals and clinics around the world. This mirrors the ways in which the same approach, Safety-II, has been welcomed by other industries. There are several differences between RHC and the established approaches, some major and others minor, that may explain why this has happened. The major of these are:

The focus of RHC is on everyday clinical work and why it usually goes well (Safety-II) rather than on unpredictable adverse outcomes, such as incidents and accidents (Safety-I).

RHC looks at work as it actually takes place (Work-as-Done) rather than at work as it is assumed or expected to be done (Work-as-Imagined). This applies to every kind of performance and for every level of the organisation – from the clinical ‘coalface’ to the management.

RHC subscribes to a system-wide perspective on how safety, quality, productivity, patient satisfaction, and more, represent facets of the same reality, and on how hospitals are complex socio-technical systems rather than streamlined ‘factories’ for the treatment of illnesses and the ‘production’ of satisfied patients.
Original languageEnglish
Title of host publicationDelivering resilient health care
EditorsErik Hollnagel, Jeffrey Braithwaite, Robert Wears
Place of PublicationAbingdon, UK
PublisherRoutledge, Taylor and Francis Group
Number of pages4
ISBN (Electronic)9780429891533, 9780429469695
ISBN (Print)9781138602250, 9781138602243
Publication statusPublished - 2018


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