Dr Carl Horsley on Safety-II in healthcare Good morning all! It's great to get to "talk" to you all in these interesting times. Peter asked me to reflect on why we started exploring Safety-II approaches in the Middlemore Critical Care.
Healthcare faces some pretty big challenges: the increasing complexity of the patients' conditions and technology; increasing demands for greater and more timely care that meets the needs of individuals and their families; limited resources including global competition for skilled staff; staff wellbeing and high rates of burnout (especially in high acuity areas like ICU); and finally the limited ability of current approaches have had in improving these issues.
We often treat these as separate issues when they may really be different aspects of the same problem: complexity.
Intensive care is an extreme example of these issues: we look after the sickest patients from our communities and around the country; our world is dynamic (think White Island/Whakaari), ambiguous (often having to act before we are certain), and complex (with many interactions between the disease, patient, technology and healthcare system). Models based on compliance or "one size fit all" are fundamentally mismatched to the nature of this world.
The central issue is therefore about "how people cope with complexity" and how can we support them to do so. This viewpoint, consistent with Safety-II, allows us to align patient-experience, quality and safety, staff wellbeing and overall system performance in a way that is cohesive and brings the different areas together. By designing for "as much as possible to go right" we can not only remove some of the classic tensions (safety vs production) but we can also engage with our staff with the key insights they bring about ways to improve both their work and the care we provide.
It has changed almost every aspect of how we work (training, incident review, intervention design etc) and transformed the unit to one focussed on adaptability in these uncertain times.