Resilient Health Care, Volume 3: Reconciling Work-as-Imagined and Work-as-Done, 1st Edition (e-Book) book cover

Resilient Health Care, Volume 3

Reconciling Work-as-Imagined and Work-as-Done, 1st Edition

Edited by Jeffrey Braithwaite, Robert L. Wears, Erik Hollnagel

CRC Press

210 pages | 11 B/W Illus.

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Hardback: 9781498780568
pub: 2016-08-22
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pub: 2016-10-03
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This book is the 3rd volume in the Resilient Health Care series. Resilient health care is a product of both the policy and managerial efforts to organize, fund and improve services, and the clinical care which is delivered directly to patients. This volume continues the lines of thought in the first two books. Where the first volume provided the rationale and basic concepts of RHC and the second teased out the everyday clinical activities which adjust and vary to create safe care, this book will look more closely at the connections between the sharp and blunt ends. Doing so will break new ground, since the systematic study in patient safety to date with few exceptions has been limited.


"This book pushes the boundaries of patient safety science and is essential reading for all those interested in creating better, safer, health systems."

—Russell Mannion, University of Birmingham, United Kingdom

"I really like the highly international nature of the chapter authorship and also the way in which chapters blended together both a resilience engineering prism and an organizational behavior perspective, which is unusual and encouraging."

Ewan Ferlie, King’s College London, United Kingdom

"The book justifies an important shift in perspective: from the ‘find-and-fix’ approach that focuses on where the system is not working to a more positive focus on how things do work and how we can learn from models of good practice."

— Trisha Greenhalgh, University of Oxford, United Kingdom

"This book builds a much needed bridge over the gap between our plans for care and the reality of practice. It makes a valuable contribution to the RHC series. As the final installment of the trilogy of books on this topic it offers a range of perspectives and challenges to thinking on this topic that will be of interest to students and practitioners interested in health care improvement and re-design."

Catherine Pope, University of Southampton, United Kingdom

"The change of perspective from Safety I to Safety II is a major breakthrough in thinking about patient safety, emphasizing the complex and dynamic interactions that characterize much healthcare practices. Putting the relation between ‘work-as-imagined’ and ‘work-as-done’ center stage, this book adds to those critical insights by offering tools (and re-analyzing existing ones) that help both scholars and practitioners in researching and designing safer healthcare systems."

— Roland Bal, Erasmus University Rotterdam, Netherlands

Table of Contents




Prologue: Why Do Our Expectations of How Work Should Be Done

Never Correspond Exactly to How Work Is Done?

Part I Problems and Issues

Jeffrey Braithwaite, Robert L. Wears and Erik Hollnagel

1. Towards a Resilient and Lean Health Care

Tarcisio Abreu Saurin, Caroline Brum Rosso and Lacey Colligan

2. The Jack Spratt Problem: The Potential Downside of Lean

Application in Health Care – A Threat to Safety II

Sam Sheps and Karen Cardiff

3. Recovery to Resilience: A Patient Perspective

Carolyn Canfield

4. Is System Resilience Maintained at the Expense of Individual


Anne-Sophie Nyssen and Pierre Bérastégui

5. Challenges in Implementing Resilient Health Care

Sheuwen Chuang and Erik Hollnagel

Part II Applications

Jeffrey Braithwaite, Robert L. Wears and Erik Hollnagel

6. Exploring Ways to Capture and Facilitate Work-as-Done

That Interact with Health Information Technology

Kazue Nakajima, Shinichi Masuda and Shin Nakajima

7. Resilience Work-as-Done in Everyday Clinical Work

Andrew Johnson and Paul Lane

vi Contents

8. Understanding Resilient Clinical Practices in Emergency

Department Ecosystems

Jeffrey Braithwaite, Robyn Clay-Williams, Garth S. Hunte

and Robert L. Wears

9. Reporting and Learning: From Extraordinary to Ordinary

Mark A. Sujan, Simone Pozzi and Carlo Valbonesi

10. Reflections on Resilience: Repertoires and System Features

Richard I. Cook and Mirjam Ekstedt

11. Power and Resilience in Practice: Fitting a ‘Square Peg in

a Round Hole’ in Everyday Clinical Work

Garth S. Hunte and Robert L. Wears

Part III Methods and Solutions

Jeffrey Braithwaite, Robert L. Wears and Erik Hollnagel

12. Modelling Resilience and Researching the Gap between

Work-as-Imagined and Work-as-Done

Janet E. Anderson, Alastair J. Ross and Peter Jaye

13. Simulation: Closing the Gap between Work-as-Imagined

and Work-as-Done

Mary Patterson, Ellen S. Deutsch and Lisa Jacobson

14. Realigning Work-as-Imagined and Work-as-Done:

Can Training Help?

Robyn Clay-Williams and Jeffrey Braithwaite

15. Resilient Procedures: Oxymoron or Innovation?

Robert L. Wears and Garth S. Hunte

16. Conclusion: Pathways Towards Reconciling WAI and WAD

Jeffrey Braithwaite, Robert L. Wears and Erik Hollnagel



About the Editors

Jeffrey Braithwaite, BA, MIR (Hons), MBA, DipLR, PhD, FAIM, FCHSM,

FFPHRCP (UK), FAcSS (UK), is foundation director, Australian Institute

of Health Innovation; director, Centre for Healthcare Resilience and

Implementation Science; and professor of health systems research, Faculty

of Medicine and Health Sciences, Macquarie University, Australia. His

research examines the changing nature of health systems, attracting funding

of more than AU$85 million (€54 million, £42 million). He has contributed

over 600 total publications and presented at international and national

conferences on more than 800 occasions, including 80 keynote addresses.

His research appears in journals such as the British Medical Journal, The Lancet,

Social Science and Medicine, BMJ Quality and Safety and the International Journal

of Quality in Health Care. He has received numerous national and international

awards for his teaching and research. Further details are available at

his Wikipedia entry: He

blogs at

Robert L. Wears, MD, PhD, MS, is an emergency physician, professor of

emergency medicine at the University of Florida and visiting professor in

the Clinical Safety Research Unit at Imperial College London. His further

training includes a master’s degree in computer science, a 1-year research

sabbatical focused on psychology and human factors in safety at the Imperial

College, followed by a PhD in industrial safety from Mines ParisTech (Ecole

Nationale Supérieure des Mines de Paris). He serves on the board of directors

of the Emergency Medicine Patient Safety Foundation, and multiple

editorial boards, including Annals of Emergency Medicine, Human Factors and

Ergonomics, Journal of Patient Safety and International Journal of Risk and Safety

in Medicine. Wears has co-edited three books, Patient Safety in Emergency

Medicine, Resilient Health Care and The Resilience of Everyday Clinical Work, and

he is working on two more. His research interests include technical work

studies, resilience engineering and patient safety as a social movement.

His research papers and commentaries have appeared in JAMA, Annals of

Emergency Medicine, Safety Science, BMJ Quality and Safety, Cognition Technology

and Work, Applied Ergonomics and Reliability Engineering and Safety Science.

Erik Hollnagel, MSc, PhD, is a professor at the Institute of Regional Health

Research, University of Southern Denmark, chief consultant at the Centre

for Quality, Region of Southern Denmark, visiting professor at the Centre for

Healthcare Resilience and Implementation Science, Macquarie University,

Australia, and professor emeritus at the Department of Computer Science,

University of Linköping, Sweden. He has through his career worked at

xii Editors universities, research centres and industries in several countries and with

problems from many domains including nuclear power generation, aerospace

and aviation, software engineering, land-based traffic and health care.

His professional interests include industrial safety, resilience engineering,

patient safety, accident investigation and modelling large-scale sociotechnical

systems. He has published widely and is the author or editor of 22 books,

including five books on resilience engineering, as well as a large number of

papers and book chapters. The latest titles, from Ashgate, are Safety-I and

Safety-II: The Past and Future of Safety Management, Resilient Health Care, The

Resilience of Everyday Clinical Work, FRAM – The Functional Resonance Analysis

Method and Resilience Engineering in Practice: A Guidebook. Hollnagel also

coordinates the Resilient Health Care Net (http://www.resilienthealthcare.

net) and the FRAMily (

Subject Categories

BISAC Subject Codes/Headings:
BUSINESS & ECONOMICS / Industries / Service Industries
MEDICAL / Administration
TECHNOLOGY & ENGINEERING / Industrial Engineering
TECHNOLOGY & ENGINEERING / Industrial Health & Safety