Using qualitative methods to understand resilience in complex systems

Abstract

In this chapter, we examine how qualitative research methods provide a natural fit for understanding the way resilience is expressed in healthcare systems. Resilience involves maintaining performance in the face of changing and potentially disruptive conditions; in healthcare, resilient performance is especially studied with reference to safety and quality. We begin by introducing the concept of healthcare as a complex adaptive system, highlighting that resilience is an emergent expression that such a system can display, and as such is inherently challenging to study or understand. Qualitative research methods are a useful way for studying complex healthcare systems, because they often involve attending to variability, relationships and influences, rather than focusing on root causes, reduction and simplification. For example, the Resilience Assessment Grid provides a framework through which we can qualitatively explore resilience, focusing on the abilities to respond, monitor, learn and anticipate. We draw on a case study of an operating theatre that responded to a critical incident by putting a number of safety measures in place, particularly an initiative of ‘staff huddles’, to demonstrate how qualitative studies enable investigations of the capacity for resilience and its expression in a system. In this case, ‘huddles’ involved a brief team meeting prior to surgeries and provided staff with protected time to collectively reflect on the surgical procedures taking place that day and therefore to learn, monitor, anticipate and respond more appropriately.