The Prize

The Problem

Despite concerted efforts to improve patient safety and quality of care, adverse events stubbornly hover at 10% of all hospital admissions. This costs health systems billions of dollars every year. In addition, less than 60% of health care encounters receive appropriate care.

Interventions such as safety improvement programs, incident monitoring, checklists, guidelines, and root cause analyses aim to improve patient safety and quality of care by reducing harm and enforcing compliance. However, apart from some isolated changes, progress has been painfully slow. There are few examples of systems level change, and insufficient evaluation of progress. We call this current approach to patient safety “Safety-I.”

The Alternative

An alternative approach to improving patient safety, called Safety-II, is based on thinking originating from resilience engineering. While traditional Safety-I initiatives have focused on finding and eliminating the causes of errors, Safety-II aims to understand how things typically go right. Safety-II can thereby serve to strengthen the naturally-occurring resilience of the health care system, providing people with new and effective approaches for addressing the intractable problems facing them.

Policymakers, managers and leaders are responsible for shaping the safety and delivery of care by planning, organising and managing the manner in which clinical work takes place. Their basis for this is a shared understanding of how work takes place (Work-as-Imagined or WAI). Actual clinical work is accomplished by those who are in direct contact with patients and who therefore are immersed in Work-as-Done (WAD). While WAD always will differ from WAI, it is important to purposefully reconcile the two. Rather than assuming that one perspective is right and the other wrong, we need to show examples—studies, case exemplars or practical demonstrations—of where the two have been successfully reconciled.

The Challenge

We challenge individuals or collaborations around the world, from academic, policy, practice or patient groups, to document their best work-in-progress, study, demonstration or ideas which help to reconcile WAI and WAD. Successful innovations must be feasible, innovative, compelling, and globally translatable; with the potential to transform how health care systems address patient safety with demonstrable practical outcomes.

WAI 2Submissions can be of several types. We expect there will be practical submissions which show reconciliation efforts that are underway, and which demonstrate how acceptable outcomes have been improved based on alignment of the perspectives. We also hope for theoretical submissions which support practice by strengthening its methodological or analytical basis. But other types are also welcome—your imagination is the only limit.

Successful applicants will propose ways to strengthen the existing resilience of health care systems by activities which improve the performance of the system by enabling it to adjust its functioning prior to, during, or following events, thereby sustaining efforts under expected and unexpected conditions. All submissions will need to present a convincing case not just for the feasibility of the proposal, but for the generalisability of their idea.

The Potential

Reconciling WAI and WAD has the potential to transform the way we manage patient safety, and deliver more effective care to patients. The prize-winning innovations will likely lead to more efficient, safe, equitable, and cost-effective health care. If the idea is translated widely, the safety of people in health care settings across the world could improve.

The Prize

Three prizes will be awarded. The best idea will receive a prize of US$5,000; second prize has been allocated US$3,000; and third prize is US$2,000.

Submissions will be assessed in light of descriptions of resilient health care in the following publications:

  • Hollnagel, E., Braithwaite, J. and Wears, R. (2013) Resilient Health Care. Surrey, Farnham, UK: Ashgate Publishing Ltd.
  • Wears, R., Hollnagel, E. and Braithwaite, J. (2015) Resilient Health Care, Volume 2: The Resilience of Everyday Clinical Work. Farnham, Surrey, UK: Ashgate Publishing Ltd.
  • Hollnagel, E., Wears, R.L. and Braithwaite, J. (2015) From Safety-I to Safety-II: A White Paper. Published simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia.

The White Paper is available at:

And the books are available from Routledge Taylor and Francis Publishing Ltd and Amazon: