Humans as an essential source of safety: a frameshift for system resilience

by Liz Boehm
Executive Strategist, Human-Centered Research

There are many ways to approach team member safety and wellbeing. The biggest debates tend to pit solutions that support individual resilience and wellbeing (i.e. breathwork, mindfulness, fitness and sleep) against system frameworks (i.e. documentation models, complex workflows, staffing shortages or operational structures).

If you listen to the Caring Greatly podcast, you may infer that my position on this debate is both-and. But I also think this debate misses some nuances of what it takes to drive both system and individual transformation. Culture is the context for both in that it reflects organizational and individual values and is the backdrop for decisions that impact team member safety and wellbeing in big and small ways.

In 2023, I had the privilege of collaborating with some industry experts on a paper, "Humans as an Essential Source of Safety: A Frameshift for System Resilience," in which we explored the implications of safety culture under a Safety I and Safety II mindset. The differences are stark – with related implications for how people within the system are valued, protected and supported.

Understanding Safety I and Safety II
A Safety I mindset places emphasis on identifying and eliminating errors by isolating the root cause. Safety I systems invite people to focus on what could go wrong. They also look at how to prevent mistakes by spotlighting what went wrong and understanding why. In doing so, Safety I systems often inadvertently place the blame for errors on people, because humans are fallible. To prevent errors, Safety I cultures tend to control people with rigid, inflexible systems and processes.

Safety II, on the other hand, focuses on what goes right and protects it. Safety II cultures recognize the importance of human judgment and adaptability in complex systems like healthcare. They regard humans as necessary for system flexibility, safety and resilience – and they protect human capacity for judgment and creativity. For individual team members, Safety II cultures tend to be more appealing, more
psychologically safe and more likely to offer careers that help develop their full strengths. For systems, Safety II offers more long-term resilience, team member retention and better patient safety.

The role of human factors science
As I mentioned, culture is the context that reflects values and sets the stage for decisions, including resource decisions. Under Safety II, one essential decision is an nvestment in human factors science, by hiring or consulting with human factors engineers. Human factors
science focuses on understanding human behaviors, proficiency and limitations to create safer, more intuitive, efficient and user-friendly systems. It means designing systems in a way that explicitly protects humans’ capacity for attention and creativity, making the right things easy to do, and respecting that healthcare requires attention, connection and creativity to succeed.

Shifting culture to design resilient systems
Creating a resilient healthcare system requires a shift in culture and leadership. Leaders must view team members as valuable resources whose capacity to contribute to system safety requires thoughtful protection. To do this, leaders need to tap into the expertise of human factors engineers to measure and manage cognitive load and other human factors of system design. By prioritizing a Safety II framework and integrating human factors science, we can improve the resilience of both the system and its workforce.

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