Reliability Versus Resilience: What Does Healthcare Need?

System performance in healthcare pivots on the ability to match demand for care with the resources that are needed to provide it. High reliability is desirable in organizations that perform inherently hazardous, highly technical tasks. However, healthcare’s high variability, diversity, partition between workers and managers, and production pressure make it difficult to employ essential aspects of high reliability organizations (HROs) such as redundancy and extensive training. A different approach is needed to understand the nature of healthcare systems and their ability to perform and survive under duress; in other words, to be resilient. The recent evolution of resilience engineering affords the opportunity to configure healthcare systems so that they are adaptable and can foresee challenges that threaten their mission. Information technology (IT) in particular can enable healthcare, as a service sector, to adapt successfully, as long as it is based on cognitive systems engineering approaches to achieve resilient performance.