Resilience and regulation, an odd couple? Consequences of Safety-II on governmental regulation of healthcare quality
Ian Leistikow, Roland Bal
Abstract
The concept of resilience, or Safety-II, is finding its way into national patient safety policies. In the Netherlands, for example, hospital, professional and patient federations have named Safety-II as one of the three pillars for the new national patient safety strategy.1 In July 2019, National Health Service (NHS) England and NHS Improvement published the NHS Patient Safety Strategy which also strives to embed Safety-II principles in the national policy.2 National policies of any kind require a form of public accountability, and for quality and safety in healthcare this accountability is mostly regulated by external, often governmental, regulatory authorities. However, while most current research on Safety-II addresses activities of front-line workers and clinical leadership, the role of external regulatory systems is hardly addressed.3 The relationship between regulation and Safety-II and the role regulators could play in improving or undermining Safety-II performance, needs investigation and theorising.4 5 In this article, we combine theory with practice examples to show how Safety-II principles could influence the interactions between healthcare providers and their regulators. In general, Safety-II is about learning from things that go right and improving resilience, where Safety-I is about learning from things that go wrong and improving compliance. The five core concepts of Safety-II are: 1. Definition of safety: ‘Safety’ is not defined as the absence of failures or adverse outcomes, which is considered ‘Safety-I thinking’, but as the ability to make things go right.6 2. Safety management: Safety management is focused on maintaining adaptive capacity to respond effectively to inevitable surprises.7 3. Role of humans: Humans are not seen as a risk, but as a resource necessary for system flexibility and resilience.7 4. Accident investigation: The purpose of accident investigations is to understand how things usually go right, since that is the basis for explaining how things occasionally …