Table 1 Defining resilience: foresight, coping and recovery elements within handover
Scenario: “Let’s imagine a meeting is occurring mid-morning on a normal working day and staff are considering what options are available should a situation arise when a night house officer does not arrive for handover (ie, is more than 30 min late for duty). The consequences of this scenario are that a fatigued clinician will have to work longer than their allocated hours and if/when a replacement is found it will be unlikely that a full and comprehensive handover will take place”
Resilience Element09:00 Monday22:00 Monday09:00 Tuesday
ForesightCopingRecovery
“The ability to predict something bad happening”“The ability to prevent something bad becoming worse”“The ability to recover from something bad once it has happened”
IndividualFor example, clinician would contact your replacement before or at shift change*For example, clinician would agree to stay on working until a replacement is foundFor example, clinician makes sure supervisory staff are aware of the situation and any patient concerns that stem from that shift
MicroFor example, supervisory clinician identifies deficits in current workforce staffing levels and escalates issue to management for shift changesFor example, having a second on-call in cases of emergency as a standard protocol to be followedFor example, cover to reduce the workload of that individual, review patients who were reviewed overnight by a fatigued clinician and organise rota for following night
MacroFor example, workforce training and standard operating procedures about handover and provisions for dedicated handover time and placeFor example, extensive documentation of clinical care by the day people identifying high-risk situations overnightFor example, get clinician home safely, review the micro team’s management of the service, and review clinical practice (may be via executive “walkaround”)
  • *However, research shows that only ∼20% of time do people do this; see Bomba and Prakash.24