Wednesday 10 Apr | 13:30-16:30

Format: Half-day workshop
Stream: Safety
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Bridge over troubled water – do workarounds support system resilience?

It’s time to think of new ways to improve patient safety.

Resilient healthcare and Safety II offer such new perspectives.

Work as done is sometimes different to work as imagined in policies and regulations.

Health professionals are able to adapt in their work practice and provide high service quality despite high workloads and often challenging and new tasks. We need to understand this much more in our safety thinking and in practice to improve. Workarounds and adaptations are potential sources of safety and must be conceptualized in new ways as they may bridge troubled water and support system resilience. But they may also mask system failure. Currently, reports repeat recommendations which are almost identical to each other have not led to a shift across the wider system. We need new perspectives and methods to understand this and translate resilience and safety II into practice and reform our systems to improve patient safety.

As a result of this workshop, participants will be able to:

• Understand basic concepts of safety II and resilience and what we mean by work as imagined and work as done.


• Have an insight into safety standard workarounds from clinical practice in different healthcare contexts. Through this, participants will explore if, how and when workarounds might contribute to system resilience.


• Test a digital resilience learning tool to translate safety II thinking and adaptive capacity into practice. Participants can return to their organizations equipped with a state-of-the-art research-based tool free of use and ready to implement.


• Have an insight into why we need to reform safety thinking in healthcare and include the voice of the patients, rather than rely on report recommendations which are failing to achieve the change needed. We can no longer accept system failures harming patients reoccurring again, and again, and again.

The workshop is organized by international clinical leaders, safety scientists, healthcare professionals and policy makers to provide a holistic perspective and international voices from England, Scotland, Sweden, Norway, and the Netherlands.

Debbie Clark University of Leeds, England

Jane O’Hara University of Cambridge, England

Rebecca Lawton NIHR Yorkshire and Humber Patient Safety Research Collaboration (YHPSRC), England

Axel Ros Region Jönköping County, Sweden

Catherine Calderwood University of Strathclyde, Scotland

Siri Wiig Stavanger University, Norway