Table 2 Principles of resilience (adapted from Wreathall25) applied to the handover
Principles of resilienceExplanationHandover example
1. Top-level commitment“Top management shows commitment towards addressing human performance concerns”Management participate in executive walk-arounds and some committee meetings looking at improving handovers
2. Just culture“Supports reporting of issues up through the organisation, yet not tolerating culpable acts”Handover rounds are supervised by senior clinicians who support speaking out about concerns of staff about safety
3. Learning culture“Organisation responds to events with repair and true reform rather than denial”Communication breakdowns in handover are examined and shared openly and widely
4. Awareness“Data gathering that provides management with insights regarding the quality of human performance, the extent to which it is a problem and the current state of the defences”Monitoring of handover is performed routinely (and specifically when changes are made, eg, when new technology is introduced)
5. Preparedness“Organisation actively anticipates human performance problems and prepares for them”Foresight, coping and recovery strategies are identified and integrated (ie, staff rotas and workforce requirements are reviewed prior to new mandated reduction in duty hours for junior doctors)
6. Flexibility“Ability for the organisation to adapt to new or complex problems in ways that maximise ability to solve the problem without disrupting operations”Allowing certain frontline clinical groups admitting privileges when senior staff are absent in order not to delay patient treatment in emergencies
7. Opacity“Organisation aware of economic, workload, and safety pressures (see: Rasmussen26) and where effort needs to be invested to ensure that defences are not degraded”Monitoring of pressures (such as budget cuts) so that strategies may be developed to ensure standards of handover practice are always maintained