Measurement of resilience potentials in emergency departments: Applications of a tailored resilience assessment grid

A proxy measurement of four resilience potentials (respond, monitor, learn, and anticipate) developed by Hollnagel is called the resilience assessment grid (RAG). This study aimed to attain an enhanced understanding of the resilience performance of emergency departments (EDs) in terms of the four potentials across hospitals through the adoption of a custom-made RAG (ED-RAG). The study setting was four hospitals. The ED-RAG questionnaire was used to interview focus groups at the four EDs from February to June 2015. All interviews were led by the lead researcher and the interview transcripts were evaluated using the ED-RAG four-point scoring scale. Four radar charts of individual resilience potentials and a star chart presenting a system's potential of overall resilience performance for each hospital's ED were generated. The charts provide visualized results that indicate clear directions for making improvement plans toward resilience in EDs. Overall, all EDs exhibited considerable potential to learn compared with the other three potentials at the time of measurement. Common strengths and weaknesses with respect to developing the four potentials were identified. Besides, no association between potential scores and staffing capacity, and no significant differences of resilience performance between hospital types were found. EDs' ability to perform in a resilient manner can be critical under considerable uncertainty and economic pressure. The study revealed essential knowledge about the development of resilience potentials in emergence departments among hospitals. The findings could contribute to the promotion of resilient health care.