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Practical Resilience: Misapplication of an Important Concept

Posted by Sam Sheps/Robert Wears on Thursday September 8th, 2016

Resilience is an important and novel concept in health care precisely because it is characterized as an emergent phenomenon of ‘work as done’. Thus within the normative context of thinking about the practical, ‘practical resilience’ is an oxymoron. Resilience as an emergent property, based on ‘anticipating surprise’, ‘a continuous preoccupation with potential for harm’, and understanding successful work will be lost in the rush to apply superficial and one-off quick fixes and ‘best practices’. Practitioners and administrators will forego thought and reflection because they now have ‘solutions’ (e.g. protocols and checklists) that can only logically be applied to ‘work as imagined’.

The dynamic nature of complex adaptive systems does not admit of such simplification. The conceptual descriptive strength of resilience is that it acknowledges and accepts that complex systems always run in degraded states (something is missing, some bit of equipment is broken, some expert is absent that day) and indeed, even if not degraded, complex systems are inherently unpredictable, have hidden interactions, and are influenced by constantly changing external factors. There will always be new dangers or paths to failure not previously experienced or imagined, and even long successful strategies can fail in surprising ways.  Thus, the only relevant and ‘ fundamentally’ practical strategy is to enhance our capabilities to anticipate and continuously be prepared to adapt and manage surprise.Otherwise we merely codify specific actions into a set of work rules and policies in an attempt to “embed” resilience (e.g. awarding “resilience champion certificates”, creating the “Resilience Tool Kits’ or ‘Resilience Roadmaps’) in what we fantasize as everyday professional practice,. Since we never can know when the operating point is very close to the safety margin until we have crossed it, it is a logical impossibility to specify a priori concrete actions that will prevent a system’s general or specific activities from moving it across the safety margin.

The practical application of resilience instrumentally will distract us from the critical task of continuing to evolve resilience thinking as an important descriptive conceptual model. Using resilience as a framework has, and will continue to, provide many examples of the success and failure modes inherent in complex systems. Our efforts therefore, should be directed towards building the capacity to reflect on, describe and emulate successful work, and to understand the factors that support or degrade it while also enhancing the capacity to recognize and adapt to threats. “Practical resilience” is folly.

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