The DARWIN Guidelines from a Healthcare Perspective

In this blog post DARWIN project partner Giuseppina Mandarino from ISS – Istituto Superiore di Sanità – in Italy looks at the benefits of the DARWIN Resilience Management Guidelines (DRMG) from a healthcare perspective. 


The usability of resilience guidelines in the healthcare domain has echoed that of air traffic management (ATM). Providing they are easily accessible and can be adapted to the activity to be performed, the guidelines can:

  • enhance brainstorming and training, and
  • give a reference list of activities for planning, updating and risk management

While analysing the best practices, methods and tools required for the adaptation of the resilience guidelines to healthcare, it was interesting and important to note how many commonalities there are between ATM and healthcare. For example, both have the same criteria for safety and quality assurance. We also discovered how, and to what extent, resilience is already rooted in the work of healthcare personnel during both routine work and unusual circumstances (even though managing resilience in this context often turns out to be challenging).

Through the feedback we received during interviews with experts, we came to the conclusion that healthcare is a complex system which often requires multitasking. Additionally, it involves a plethora of actors, ranging from surgeons to nurses and to technicians, and from regulatory bodies, to providers and to training organisations. This complexity invariably leads to an enormous variety of systems and processes. We were presented with some examples from healthcare where such a variety is unnecessary because it brings about avoidable and preventable harm to the patients. This, in turn, hampers standardisation and leads to confusion.

In this complexity, people are at the same time a source of brittleness – challenging the flexibility and resilience of the system.

Again, what has been illustrated in ATM regarding culture is somewhat more evident in healthcare, since the blame and shame culture is more deeply rooted in this domain, and, sometimes, hampers the open flow of information and learning about vulnerabilities. The reason for this is provided by several factors. Among them, we can include:

  • a much broader range of actors involved and lack of relevant training
  • complex equipment and information systems. These, in fact, can also contribute to brittleness as sometimes information technology (IT) systems that are installed in an attempt to fix problems show how the problems are actually embedded in the social organisation
  • hierarchies within professions that tend to be rigid and relationships between professions and specialties complicated by issues of power and status

Our work setting up the guidelines aims to make a real contribution to the creation of conditions that progressively solve all of the biases, errors and problems that permeate this domain.

The implementation of brittleness exercises and assessments requires an organisational context, with the support of management. This adds value by encouraging a proactive approach to crisis response, where personnel can provide input, and report errors or failures.


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