Resilience and systems engineering

Abstract

Pediatric cardiac surgery is a complex, high-risk field characterized by a vulnerable patient population, technically demanding surgery, and technological and team challenges. Human factor studies have identified the importance of teamwork, communication, and standardization of some processes of care to improve outcomes. With demonstrable improvement in safety still lacking, continued reflection is warranted on the fundamental concepts which underlie safety efforts. Most studies have adapted a linear accident model with emphasis on error commission and recovery, adverse events, and latent conditions. More recent approaches to safety based on systems and resilience engineering are more applicable to complex systems of care, such as cardiac surgery. Systems engineering seeks to minimize risk through redesign. Resilience engineering explores how individuals and organizations negotiate complexity to create safety.