ABSTRACT
This chapter focuses on dynamics related to safety-production goal conflicts. Problems in the US healthcare delivery system provide another informative case where faster, better, cheaper pressures conflict with safety and other chronic goals. The Institute of Medicine in a calculated strategy to guide national improvements in health care delivery conducted a series of assessments. Safety, access, patient-centeredness are chronic goals in the sense that they are system properties that emerge from the interaction of elements in the system and play out over longer time frames. For example, safety is an emergent system property, arising in the interactions across components, subsystems, software, organizations, and human behavior. The basic issue for organizational design is how large-scale systems can cope with complexity, especially the pace of change and coupling across parts that accompany the methods that advance the acute goals. Resilience engineering needs to identify the classes of dynamics that undermine resilience and result in organizations that act riskier than they realize.
