[1] Furniss, D., Back, J., Blandford, A., Hildebrandt, M., Broberg, H. (2011). A resilience markers framework for small teams. Reliability Engineering and System Safety, 96(1), 2–10.[2] Furniss, D., Back, J. & Blandford, A. (2011). Unwritten Rules for Safety and Performance in an Oncology Day Care Unit: Testing the Resilience Markers Framework. Proc. Fourth Resilience Engineering Symposium 93–99. Paris: Presses des Mines.[3] Day, J., & Buchanan, G. & Makri, S. (2015). Learning Lessons from Controlled Studies to Elicit and Investigate Users’ Resilience Strategies. Poster to be presented at the 15th IFIP TC13 Conference on Human-Computer Interaction (INTERACT 2015), Bamburg, Germany, September 2015.

[4] Furniss, D., Back, J., & Blandford, A. (2012). Cognitive resilience: Can we use Twitter to make

strategies more tangible? Proceedings of European Conference on Cognitive Ergonomics (ECCE 2012), 96–99. New York: ACM.[5] Furniss, D., Barber, N., Lyons. I., Eliasson, L., & Blandford, A. (2014). Unintentional nonadherence: Can a spoonful of resilience help the medicine go down? BMJ Quality & Safety.[6] Day, J., Furniss, D. & Buchanan, G. (2015). Meals and Ingredients: Coping with Compound Resilience Strategies. Paper to be presented at the 6th Symposium of the Resilience Engineering Association, Lisbon, Portugal, June 2015.

A surgeon interacts with a system behind apron while ‘scrubbed-up’, reducing time cost of removing & reapply gloves while maintaining sterility

Users sometimes supplement interfaces or devices with improvised notes, in order to remind them as to a particular threat, flaw or corresponding strategy

When Things Go Right: Learning from Resilience Strategies

Jonathan Day, George Buchanan & Stephann Makri

Centre for HCI Design, City University London, UK

In healthcare, as in much safety critical work, there can be a very fine line between an adverse event occurring or it being averted. While adverse events invite scrutiny and investigation, relatively little effort is invested into better understanding the positive interventions that people make to pre-empt or negate threats, and avoid such events from occurring in the first place. Such instances occur frequently and yet are not often recognised or harnessed as a means to improve safety or performance. The work described here articulates the concept of resilience strategies, briefly describes some of our work in the area, and intends to promote mindfulness and reflection as to the lessons that practitioners (both within and beyond HCI) can learn from these often-overlooked everyday tactics and behaviours.

As technology becomes increasingly embedded in healthcare provision, one pertinent and pervasive risk is user error. Unfortunately, no matter how well implemented a system or interface may be, a multitude of potential threats beyond the design envelope persist. Challenges arising from real-world situated use (such as interruptions in the environment or technological frailties, both of which are frequently observed in clinical environments), or inherent vulnerabilities in human performance (e.g. lapses in memory, cognitive slips, or other symptoms of stress or fatigue), can negatively impact performance or even patient outcomes. Where such threats exist in the frontline operation of interactive systems, it often falls to users to actively manage such threats and maintain performance.

Fortunately, errors and incidents are frequently averted by the forethought, adaptability and resilience of these frontline operators. This can take a myriad of forms, for example: the use of cues to assist prospective memory, the appropriation or repurposing of artefacts (be they physical, digital or informational), or the active adaptation of task or routine structure. Each of these, and many more such behaviours, are observable not only in medical settings but across all manner of tasks and settings. It is tactics and strategies such as these, when motivated by or resulting in a positive contribution to safety or performance, that we term resilience strategies.

As part of work undertaken by the CHI+MED project, we have carried out a number of studies, combining different methodologies, with different communities to explore resilience strategies across a number of settings [1, 2, 3]. Our research has developed new ways to recognise, describe and make sense of these strategies [4, 5, 6]. We have stimulated discussion across a range of audiences and venues, promoting the value of considering what goes right in everyday interactions, not just what goes wrong.

We continue to encourage both researchers and practitioners (healthcare and otherwise) and the wider public, to recognise and consider the impact of resilience strategies in their own work and everyday situations. By better understanding these resilience strategies and behaviours, insight could be gained into how future systems may be better-designed to support and accommodate for users’ strategies and resilient practices.

Challenging Environments & The Need for Resilience

What are Resilience Strategies?

CHI+MED Work into Resilience Strategies

Selected References & Further Reading