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Minding the Gaps: Creating Resilience in Health Care.


In: Henriksen K, Battles JB, Keyes MA, Grady ML, editors.


Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug.
Advances in Patient Safety.

Author information

Cognitive Technologies Laboratory, The University of Chicago, Chicago, IL (Dr. Nemeth, Dr. Cook); Department of Emergency Medicine, University of Florida, Jacksonville, FL (Dr. Wears); Cognitive Systems Engineering Laboratory, Department of Integrated Systems Engineering, The Ohio State University, Columbus, OH (Dr. Woods); École des Mines de Paris, Crisis and Risk Research Centre, Sophia-Antipolis Cedex, FR (Dr. Hollnagel)


Resilience is the intrinsic ability of a system to adjust its functioning prior to, during, or following changes and disturbances so that it can sustain required operations, even after a major mishap or in the presence of continuous stress. As an emergent property of systems that is not tied to tallies of adverse events or estimates of their probability, resilience provides the means for organizations to target resource investments by integrating safety and productivity concerns. Resilience engineering (RE) can enable an organization to cope with and recover from unexpected developments, such as maintaining the ability to adapt when demands go beyond an organization’s customary operating boundary. Understanding resilience makes the difference between organizations that inadvertently create complexity and miss signals that risks are increasing, and those that can manage high-hazard processes well. We discuss two examples of resilience: the response of an emergency department staff to surges in patient volume and design improvements to the infusion device control/display interface.

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