From Standardization to Resilience: How Day-To-Day Life in Healthcare Organizations Shapes Safety

This paper focuses on the working strategies nurses develop and employ in their day-to-day routine in an attempt to identify "red alerts" which enable them to maintain patient safety despite the load and interruptions characterizing their work environment. Based on insights gained from three studies (focusing on nurses’ medication administration, use of protective measures and transferring information during handover) we develop a theoretical model that describes how understanding aspects of the day-to-day life in healthcare organizations, and the system of meaning that guides everyday life, can inform our understanding of workplace safety. The model illustrates how the chaotic, turbulent, and complex environment characterizing the nurses' workplace prevents them from fully complying with the declared safety goals practices and procedures. Yet even under these near-impossible circumstances, the nurses’ main mission is to maintain patients' safety. Embracing a resilience strategy allows nurses to actively prevent something bad from happening or becoming worse, and to repair something bad once it has occurred, which of course contribute to patient’s safety. Otherwise, nurses might rely on an implicit theories strategy, limiting the likelihood that they will discover their misperceptions, thereby putting patients' safety at risk. The model further describes how each of these two strategies is reinforced by positive feedback loops on the individual, ward, and organizational levels. Practical implications for managers include work practices that can encourage nurses’ resilience by creating a work environment of professionalism, mindfulness and awareness of errors.