Exploring safety, quality and resilience in health care

There still appears to be much to do to make the National Health Service in England a safer place for patients. Hospitals, in particular, are complex organisations in which staff and processes are under the twin simultaneous demands of an increasingly aged society and severe financial constraints. While much health care is well delivered, there remains a need to predict, and to explore, where and why problems occur. This thesis presents work which has refined methods and tools that can be used at health system and organisation levels to explore some key safety and quality issues in health care.
The six publications presented and discussed here were published during a seven year period between 2006 and 2013. They explore three important issues relating to safer health care – safety culture and incident reporting, prospective hazard analysis, and the use of improved case note review methods to evaluate the safety and quality of care in hospitals.
Two principal approaches to data access are presented in the publications. At the system and organisation level, information from large data sets was used to investigate the relationships between markers of safety and quality. At the health care provision level, data has been gathered about the work of health care professionals using mixed-methods approaches.
The publications are discussed across two inter-related concepts – healthcare safety and healthcare resilience. While the study of safer healthcare has a long history the concept of healthcare resilience is still being developed. Resilience is concerned with the way in which organisations and people can adjust and maintain their functioning in the face of challenge or adversity. Although the presented publications themselves do not explicitly consider research into resilience, this theme is used to reflect on the study results and their potential value to health services.