Unintentional non-adherence: can a spoon full of resilience help the medicine go down?

To cite: Furniss D, Barber N, Lyons I, et al. BMJ Qual Saf Published Online First: [please include Day Month Year] doi:10.1136/bmjqs-2013002276 INTRODUCTION Non-adherence to medication is a ‘worldwide problem of striking magnitude’. It has consequences for the health of patients and is a great concern for healthcare providers in terms of patient outcomes and healthcare costs. Theoretical research has mainly focused on intentional non-adherence: for example, when people choose not to take their medication. However, unintentional non-adherence also accounts for a significant proportion of the problem: when people mean to take their medication in the right way but do not. This area is underresearched. In this paper, we bring a new perspective to this problem by exploring what contribution ‘resilience’ could make to it. Resilience engineering focuses on a system’s ability to maintain performance, avoid error, compensate for poor circumstances and cope with disturbances. So, rather than focus on how things go wrong, we propose to exploit and enhance how things go right.