Marjon Borgert

204 Chapter 9 anticipate when errors will occur. 49 Transforming hospitals into HROs is impossible unless leaders at all organizational levels are fully committed to achieving safe and high-quality patient care. There are ve principles that guide HRO thinking, and help to focus on emergent risks and select the right set of interventions for addressing them: 1) preoccupation with failure; 2) reluctance to simplify interpretations; 3) sensitivity to operations; 4) deference to expertise; and 5) commitment to resilience. 52 Embracing the HRO approach might be challenging in hospitals, where there are cost restraints and a high turnover of team members. It will be interesting to see whether hospitals can achieve this state of high reliability, how they achieved this, and, most importantly, how they sustain this state. Healthcare is rapidly changing in many di erent ways. More people live with one or more chronic disease such as kidney disease, diabetes, cardiovascular disease or cancer. Diseases that were once fatal have become more and more chronic conditions. 35 In the near future, hospitals will be focussing more on treatments and procedures requiring high levels of expertise using innovative techniques. More innovative medications, procedures, techniques, therapies have been developed and introduced leading to much shorter hospital stays. Patients will be discharged from the hospital sooner and care will be delivered in the patients homes or in centres outside the hospital. The changes in healthcare has implications for professionals as well. One interesting change is the role and tasks of physicians and nurses. This is rapidly changing since more care can be provided by specialized nurses instead of by physicians. Physicians will have a greater role in supervising and in making complex decisions. 35 These are only a few examples that indicates that healthcare is rapidly changing. Due to these changes new risks will be created. Like Vincent argues, we must expand our view on patient safety. 35 An interesting development is the approach of resilient healthcare. 53 This approach is often called the‘Safety II’approach. Safety II is not meant as a replacement of the current approach on safety rather to use complimentary. 53 From this point of view healthcare is resilient and the daily care is more often successful than that it fails. Thus, instead of focussing on the errors and the things that go wrong, the focus should be the other way around, i.e. focussing on the positive things and learn from it. This forms the basis of understanding why errors sometimes do occur in healthcare. Errors do not occur because healthcare providers react as they are told to, but they adjust to the varying circumstances to do the right thing for the patient. In the future, methods for such analyses should be more explored and investigated in di erent contexts. 35