A respected authority on patient safety and simulation, Dr. Ellen Deutsch heads a state-wide association that monitors patient safety and reviews harmful events in that area. During her lecture at McGill University’s Combined Surgical and Anesthesia Grand Rounds, she discussed the concept of health care delivery as a human-modified system, and invited the audience to reflect on whether the humans were the problem or actually the asset in our efforts to provide safe health care.
“Humans are a great resource working in very difficult conditions. In order to improve health care, we have to pay attention to the systems we work in. Health care systems are complex adaptive systems that are constantly evolving,” she explains. “We continually adjust how we work under resource constraints and changing environmental conditions, facing boundaries, pressures and goals that compete with each other. Sometimes, the boundary of what's safe is not clear.”
In order to be efficient, we need to be resilient and adapt to whatever comes our way so that we can do our best for our patients. You cannot make a system be resilient, but you can create conditions to allow resilience to emerge—and you can create conditions that interfere with resilience emerging. The main capacities of resilience are the ability to learn, respond, monitor and anticipate.
Dr. Deutsch explained the concept of “work as imagined” (conceptual, high-level) versus “work as actually done” and discussed how simulation allows us to gather information to prevent patient harm by identifying threats. “In-situ simulation using real teams, real patients and real patient care settings can help us understand the health care delivery environment, identify latent hazards and system issues, and enhance our adaptive capacity. Simulation is powerful and may come the closest to “work as done,” says Dr. Deutsch.
She also point out that sometimes things go well precisely because people compensated; we need to understand what that compensation is, and not consider it waste. We need to reinforce things that go well and prioritize debriefing successful activities.
Both the science of resilience engineering and the science of human factors support the conclusion that humans are the asset and the strong point and foundation of the system. Humans have limitations but they also have tremendous capabilities: they solve problems, they create, they invent, and they improve. Humans are awesome!