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. The burden of lives lost, and suffering, is grave; it also 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 make things safer for patients, and enhance the quality of patient safety and quality of care, by reducing the risk of being harmed, 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. This current approach to patient safety is labelled “Safety-I.”

The Alternative

An alternative approach to improving patient safety, Safety-II, is based on thinking originating from resilience engineering. While traditional Safety-I initiatives have focused on finding and removing the causes of errors, Safety-II aims to understand how things typically go right. Safety-II can thereby serve to improve and strengthen the how things go well by 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, both are important in enabling resilience engineering to work in practice.

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 document how resilience engineering principles can be applied in health care settings. 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.

We expect these 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. 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 their application, but also for the generalisability of their idea.

The Potential

Applying resilience engineering 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 deployable ideas for 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.

Closing date for all submissions is: Midnight 18 June 2018.

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.
  • Braithwaite, J., Wears, R. and Hollnagel, E. (2017) Reconciling Work-as-Imagined and Work-as-Done. Abingdon, UK: Taylor & Francis 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: