by Stephan Ore, Erik Hollnagel and Ivonne Herrera
The Resilience Performance Enhancement Toolkit (RPET) is proposed and used as debriefing tool to explore everyday work. Its purpose is not to seek answers to specific questions but rather to stimulate people to reflect on the practices, formal and informal strategies that makes the health care system works. The tool was introduced in hospitals in Sweden in 2018 (for more details click here). In 2019, a pilot was conducted in six diverse healthcare units by healthcare personnel in Norway. The units represent diverse context and different needs. Among others, these were a somatic LTC nursing home for the elderly (Oppsalhjemmet, Oslo), a dementia department at a LTC nursing home (Uranienborghjemmet), an oncology department (Arkershus University Hospital), a clinic for substance abuse and mental health (Venstre Viken), and youth welfare institution (Sandefjord). The tool was used to learn from everyday reflection. A template was distributed to all units and it was adapted in diverse ways. After short introduction to resilience engineering and the tool, the healthcare representatives implemented the tool themselves. Academics were at hand for guidance when needed but not involved in the direct implementation.
The three hospital wards included in the pilot-study had just implemented the patient safety tool The Green Cross. The teams swapped the negative focus in the original method (“Have we had a workday free from harm”) to the positive RPET-questions (“Did something go well today? etc) and thereby renaming it The Green Cross V2!
The following are testimonials from the participants participating in the implementation (Patient Safety Conference 2019):
- In the nursing home, “the nurse assistant had an idea on an improvement measure that motivate an elder person to eat breakfast – focusing on “what is important for you today?” – a positive experience“
- In the oncology department, “information was adapted to a cancer patient including his family and children. This highlighted the importance to arrange a meeting that considers important people for the patient and good communication – a reflection to learn“
- A new employee at the clinic for substance abuse found the tool as “really sympathetic, open for organic questions, allow to know what other colleagues stands for, works for debriefing, playful, fun with the colour markers, astonishingly meaningful and want to continue to use it“
- In the dementia department, the tool “change the focus for what did not go so well to include what went well, what went well today, with a small question the mood changes very fast, incredible how little it takes“
- A possibility to share the small things that makes the difference “what went well today? I finally managed to shower one particular resident that never accepts this. What did you do? I play a song! We tried again and it works every time“
- In the child protection institution, there was a person very negative to the therapist. By using RPET the tool “allowed self-reflection, positive toward the positive issues and created a better relationship with the patient“
The above just reflect views on the application of the tool. This note is an invitation for other to try and share experiences on resilience in practice.