Human factors and resilience
Human Factors and Resilience research stream is part of the Centre for Healthcare Resilience and Implementation Science at the Australian Institute of Health Innovation.
While the rate of medical error remains stubbornly high at around 10 percent in modern hospital systems, there are considerable untapped opportunities to improve care by turning our attention to what healthcare systems do well.
Resilient Health Care (RHC; also known as ‘Safety-II’ and ‘Safety Differently’) is a new patient safety approach, created in 2013 from the field of resilience engineering. Healthcare must adapt to deal with the unexpected (eg. COVID-19), and RHC explores safe ways to do so. RHC aims to reduce patient harm through understanding variation in day-to-day clinical work and using human factors principles to design more effective, efficient and safe workplace processes. RHC is a systems approach that, in addition to variation in an individual’s work, considers the impact of interactions between clinical team members, between clinicians and the patients they treat, between patient care teams, across hospital departments, and between organisations. RHC thinking is increasingly applied worldwide in clinical practice, management and leadership, and in application of policy, where traditional solutions to safety are ineffective due to system complexity.
The Human Factors and Resilience stream, led by Professor Robyn Clay-Williams, is pioneering a new approach to RHC which incorporates human factors principles and system modelling to understand and improve the way health systems function. This work has led to new health services research methods: Functional Resonance Analysis Method (FRAM) enables workplace processes to be mapped, to better understand where variation occurs and to identify leverage points for process improvement. Cognitive Work Analysis (CWA) models an entire workplace (e.g. an Emergency Department), and enables quality improvement interventions to be tested on the model, and human and non-human resource implications identified, prior to implementation. These are practical tools that facilitate effective, sustainable quality improvement.
Professor Robyn Clay-Williams | Dr Elizabeth Austin | |
| Lieke Richardson Research Assistant E: lieke.richardson@mq.edu.au |
Selected stream projects
Rouse Hill Hospital Development Project
The Deepening our Understanding of Quality in Australia (DUQuA) project
Organisational Resilience at Townsville Hospital project
Investigating methods for improving productive safety in hospital Emergency Departments: a Cognitive Work Analysis (CWA)
Selected publications
Austin E, Blakely B, Salmon P, Braithwaite J, Clay-Williams R. The scope for adaptive capacity in Emergency Departments: Modelling performance constraints using Control Task Analysis and Social Organisational Cooperation Analysis. Ergonomics 2021 https://doi.org/10.1080/00140139.2021.1992004
Austin E, Blakely B, Salmon P, Braithwaite J, Clay-Williams R. Identifying constraints on everyday clinical practice: Applying Work Domain Analysis (WDA) to Emergency Department care. Human Factors 2021:0018720821995668 https://doi.org/10.1177/0018720821995668
Austin E, Blakely B, Salmon P, Braithwaite J, Clay-Williams R. Technology in the Emergency Department: Using Cognitive Work Analysis to model and design sustainable systems. Safety Science 2021;147:105613 https://doi.org/10.1016/j.ssci.2021.105613
Austin E, Blakely B, Salmon P, Braithwaite J, Clay-Williams R. Strategies to measure and improve Emergency Department performance: A scoping review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2020;28(1):1-14 https://doi.org/10.1186/s13049-020-00749-2
Clay-Williams R, Braithwaite J. Resilient Health Care: a determinant framework for understanding variation in everyday work and designing sustainable digital health systems. In: Scott P, de Keizer N, Georgiou A, editors. Applied interdisciplinary theory in health informatics: a knowledge base for practitioners. Netherlands: IOS Press, 2019.
de Vos M, Damen N, Braithwaite J, Moesker M, de Lind van Wijngaarden R, Kaplan J, Clay-Williams R. Preoperative anticoagulation management in everyday clinical practice: an international comparative analysis of work-as-done using the functional resonance analysis method. Journal of Patient Safety 2021:17 (3), 157-165 doi: 10.1097/PTS.0000000000000515
Clay-Williams R, Rapport F, Braithwaite J. The Australian health system response to COVID-19 from a Resilient Health Care perspective: what have we learned? Public Health Research & Practice 2020:9;30(4):1-6. https://doi.org/10.17061/phrp3042025
Selwood A, Blakely B, Senthuran S, Lane P, North J, and Clay-Williams R. Variability in clinicians’ understanding and reported methods of identifying high-risk surgical patients: a qualitative study. BMC Health Services Research 2020:20;427. https://doi.org/10.1186/s12913-020-05316-0
Buikstra E, Strivens E, Clay-Williams R. Understanding Variability in Discharge Planning Processes for the Older Person. Safety Science 2020;121, 137-146. https://doi.org/10.1016/j.ssci.2019.08.026
Clay-Williams R, Blakely B, Lane P, Senthuran S, Johnson A. Improving decision making in acute health care through implementation of an Intensive Care Unit (ICU) intervention in Australia: a multi method study. BMJ Open 2019;9(3). doi: 10.1136/bmjopen-2018-025041
Clay-Williams R, Hounsgaard J, Hollnagel E. Where the rubber meets the road: using FRAM to align work-as-imagined with work-as-done when implementing clinical guidelines. Implementation Science 2015;10(1)1-8 https://doi.org/10.1186/s13012-015-0317-y
Clay-Williams R, Colligan L. Back to basics: checklists in aviation and healthcare. BMJ Quality & Safety 2015;24(7):428-431 http://dx.doi.org/10.1136/bmjqs-2015-003957
Braithwaite J, Clay-Williams R, Nugus P, Plumb J. Health care as a complex adaptive system. In: Hollnagel E, Braithwaite J, Wears R, editors. Resilient Health Care. Surrey, UK: Ashgate Publishing Limited, 2013
More resilient healthcare articles by Professor Jeffrey Braithwaite.
Other resources
Emergency Department Work Domain Analysis Model: Making the Complex, Simple
Resilient Health Care Network website
A Human Factors Resource for Health Professionals and Health Services Staff
SQAN Webinar: Building Resilient Systems for Surgical Improvement from BCPSQC on Vimeo.
Centres related to this research
Content owner: Australian Institute of Health Innovation Last updated: 27 Feb 2024 6:48pm