Two worlds colliding: exploring the boundaries between system resilience and individual resilience

Professor Janet Anderson and Dr. Louise Ellis discussed the similarities and differences between the individual and system focus and posed the question of whether Resilient Health Care should focus more on individual resilience. Professor Anderson’s perspective is that Resilient Health Care (RHC) should emphasise the benefits of a systems approach to improving healthcare. RHC has always had a systems perspective and this is now increasingly recognised as important in ensuring high quality care. It means that healthcare systems are complex and dynamic, with non-linear interactions between system elements. Behaviour and outcomes emerge from this complexity and are not fully predictable. We cannot understand such a system by studying it in a reductionist way and RHC research has made progress in developing methods and approaches that take this complexity into account. Although still developing, RHC offers a coherent theory and methods that are of value to the wider healthcare and academic communities. You can read more about the Resilient Health Care Society on their website.

“It is true that healthcare practitioners are part of the system and that their individual resilience affects how the system functions. However, I argued that the focus of RHC work should be on the complexity of system interactions rather than on individuals. Other disciplines have a research tradition and evidence base for addressing individual psychological resilience and RHC can make a bigger impact by continuing to develop the theory and methods of complex systems. We need to resist attempts to make individuals responsible for bad system design by implying that they should become more resilient,” says Anderson.

Development of new systems and methods

Resilient Health Care can contribute more by continuing to develop methods such as FRAM and Cognitive Work Analysis that model system interactions as a basis for design, and in depth qualitative and theoretically informed analyses that identify system complexity and interactions. The defining characteristic of the RHC approach is that the system is the unit of analysis rather than individuals. Complex systems such as healthcare cannot be fully controlled, but modelling the complexity can help to identify how systems can be influenced to shift towards more desirable states.

“Interestingly, healthcare organisations and policy makers appear to be developing an appreciation for complexity and how it affects quality and quality improvement. I believe this is therefore the right time to capitalise on the theoretical and methodological insights of RHC by concentrating on the core offerings of RHC – a systems perspective and methods for applying it,” says Anderson in conclusion.

The next RHCS webinar is about patients and families engaged in resilient healthcare systems on february 16th. Contact Inger Johanne Bergerød for more information.

Text: Eigil Kloster Osmundsen