Organisational Resilience in Healthcare
Research type
Research Study
Full title
Improving Organisational Resilience in Acute and Mental Health Settings
IRAS ID
244311
Contact name
Ara Darzi
Contact email
Sponsor organisation
Imperial College London
Duration of Study in the UK
2 years, 0 months, 1 days
Research summary
Summary of Research
The safe and effective management and treatment of patients relies on multiple healthcare professionals, from a variety of healthcare disciplines, working collaboratively together to share knowledge and information and coordinate tasks. Frequently failures of care are a result of poor team communication and gaps between professional groups.
Our observations have shown that multi-disciplinary teams vary greatly in the way they operate, including the degree of participation, the openness of the discussion and the contributions of team members to decisions about patient care. Multiple factors may contribute to this variability including: hierarchy, available resources, staff attitudes, ward culture and the pressures or challenges faced by the hospital, trust or National Health Service more broadly.
Organisational resilience is the ability of a system to adapt safely to pressures or changes within it. Resilience Engineering looks for ways to improve a systems’ ability to successfully adapt under varying conditions. Systems with resilient performance are able to flexibly: respond, monitor, learn and anticipate.
The research team have developed methods to examine organisational resilience in healthcare settings, employing observational analysis of healthcare teams alongside qualitative interviews and focus groups with staff. This data inform development of the Resilience Analysis Grid (RAG), an intervention designed to enable healthcare staff to reflect and provide feedback on, organisational resilience in their clinical environment. To date this approach has only been applied to single clinical wards in acute care settings.
The aim of this study is to build on this previous work, examining organisational resilience across multiple clinical wards in both acute and mental health settings. This will provide teams with tools to share feedback about resilience in their workplace, and will identify areas of concern that can be targeted through tailored interventions, ultimately improving patient safety.Summary of Results
The aim of this study was to examine the capacity of a hospital system to adapt safely to pressures and problems.
This was a mixed methods study employing ethnographic observations alongside in-depth evaluations of staff perceptions.
Ethnographic observations revealed different types of teams across the hospital distinguishable based on their (i) membership stability (stable/dynamic membership or both), (ii) location within the hospital (fixed/ mobile), (iii) tasks (planned work/responsive to urgent clinical need) and (iv) function (coordinating organisational goals vs clinical goals).
Misalignments between demand and capacity were regularly experienced by all the team types observed. However, the frequency with which they occurred, how they were managed, and the ability of the team to effectively adapt varied according to the team type.
Quantitative analysis of questionnaires disseminated to staff revealed that Team performance was predicted by psychological safety, low interpersonal conflict and low reliance on team members’ untested knowledge.
Taken together, these findings highlight the importance of a supportive and psychologically safe team culture alongside social organisation of teams in facilitating effective adaptation to changing demands and providing safe care in hospitals.REC name
Wales REC 7
REC reference
18/WA/0218
Date of REC Opinion
6 Jul 2018
REC opinion
Further Information Favourable Opinion