Using workarounds to examine characteristics of resilience in action

Health care organisations (Jordon et al., 2010; Sittig and Singh, 2010) and the profession of nursing (Chaffee and McNeill, 2007) have been characterised as complex adaptive systems (Braithwaite et al., 2013), with uneven and undulating demands and barriers to delivering care. Every day across the world millions of clinicians deliver safe patient care. They do this within complex systems that use traditional approaches to patient safety, approaches that apply linear type solutions to a complex adaptive system, in an attempt to constrain and avoid variability. These solutions often include policies, rules, regulations and technology developed to enforce standardisation of clinical practice. An ability to adapt, predict, adjust and compensate for system barriers and shortcomings are characteristics of experienced and resilient employees (Tucker and Edmondson, 2003; Hollnagel, Braithwaite and Wears, 2013c; Wears, Hollnagel and Braithwaite, 2015a; Braithwaite, Wears and Hollnagel, 2017).