ABSTRACT
There is a growing realisation that traditional approaches to the quality and safety of health care are not sufficient for making significant improvements (Vincent et al., 2008; Hollnagel, 2013). Reactively counting and investigating adverse events to identify causes and develop solutions is the dominant approach and it is neither straightforward, reliable nor particularly helpful (Anderson et al., 2013). Even if this approach is optimally carried out, it would not be sufficient to ensure safe and high quality care because it is based on a fundamentally flawed understanding of human psychology and how work is achieved in a complex system. Drawing on ideas in complexity, engineering and ecology, resilience engineering suggests a different approach. It provides insights into how care quality results from multiple interacting factors (Patterson et al., 2006) and alludes to tantalising clues about how we might proceed to harness these insights to improve quality. There is now a need to translate the insights into operationalised concepts, and a course of action, if we are to realise the full potential of the approach. In this chapter we begin to explore how we can move the field forward by considering monitoring, one of the four cornerstones of resilience proposed by Hollnagel (2009a). We explore how monitoring for resilience can be operationalised and how it should be grounded in the science of human performance.
