Developing a System Resilience Approach to the Improvement of Patient Safety in NHS Hospitals

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Developing a System Resilience Approach to the Improvement of Patient Safety in NHS Hospitals

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dc.contributor.author Williams, Michael Dermot Andrew en_US
dc.date.accessioned 2011-11-02T16:42:57Z en_US
dc.date.accessioned 2013-03-21T10:25:34Z
dc.date.issued 2011-04-05 en_US
dc.description.abstract The objective of this thesis is to explore how a systems approach can be used to provide an insight into patient safety in NHS hospitals in England. Healthcare delivers considerable benefits yet there remains a relatively high rate of harm and death for patients through adverse events occurring during the process of treatment. The extant patient safety literature acknowledges the influence of organisational or system factors on patient safety. However, the literature is weak in explaining how system factors affect patient safety. To provide an insight into the interactions within healthcare systems, this research explores the characteristics of NHS hospitals, regarded as complex socio-technical systems, using concepts from resilience, systems, accident and social theory. A theoretical Safe Working Envelope (SWE) model (Rasmussen, 1997) is developed and contextualised for use in the NHS. The case study field work was carried out in two NHS hospitals during consecutive winter months at times of high demand for inpatient services. A third case study uses secondary data about patient safety failures in the Mid Staffordshire NHS Foundation Trust. The original SWE model has three failure boundaries. The model is developed by introducing an additional boundary to take account of Government targets. Social theory and system dynamics are used to include the dialectic feedback of social actors and the dynamics of workload. The model depicts the competing pressures, constraints and the workload associated with the need to meet the financial, target, staff workload and patient safety requirements. Three interacting construct sets are explored. These are the constraints within which the system operates, the pressures from the context, and the system dynamics of demand, capacity and decision making. Insights into system behaviours of the hospitals are derived from examining the construct set interactions. The proposition is made that there are five system behaviour archetypes which create the conditions that influence patient safety. The archetypes are derived from the system dynamics and in particular the relationship between reinforcing and balancing feedback loops. The five archetypes are safe practice, drift, tip, collapse and transition towards failure. As hospitals become overcrowded the complexity increases and the reinforcing feedback loops dominate the system and potentially increase the risk to patients. An element of risk arises from staff normalising to the drift in standards of care. en_GB
dc.description.sponsorship NHS South West Strategic Health Authority en_GB
dc.identifier.uri http://hdl.handle.net/10036/3256 en_US
dc.language.iso en en_GB
dc.publisher University of Exeter en_GB
dc.subject patient safety en_GB
dc.subject resilience en_GB
dc.subject system dynamics en_GB
dc.subject NHS hospitals en_GB
dc.subject safe working envelope en_GB
dc.subject targets en_GB
dc.subject staff workload en_GB
dc.subject finance en_GB
dc.subject Normalisation en_GB
dc.subject Drift en_GB
dc.title Developing a System Resilience Approach to the Improvement of Patient Safety in NHS Hospitals en_GB
dc.type Thesis or dissertation en_GB
dc.date.available 2011-11-02T16:42:57Z en_US
dc.date.available 2013-03-21T10:25:34Z
dc.contributor.advisor Smart, P.A. en_US
dc.contributor.advisor Maull, Roger en_US
dc.description Developing a system resilience approach using Rasmussen's (1997) safe working envelope to develop theory about patient safety failure in NHS hospitals. Case study research design with multiple data collection methods. en_GB
dc.publisher.department Management en_GB
dc.type.degreetitle PhD in Management Studies en_GB
dc.type.qualificationlevel Doctoral en_GB
dc.type.qualificationname PhD en_GB


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