Managing clinical failure: a complex adaptive system perspective

The purpose of this article is to explore the knowledge capture process at the clinical level. It aims to identify factors that enable or constrain learning. The study applies complex adaptive system thinking principles to reconcile learning within the NHS.

The paper uses a qualitative exploratory study with an interpretative methodological stance set in a secondary care NHS Trust. Semi-structured interviews were conducted with healthcare practitioners and managers involved at both strategic and operational risk management processes.

A network structure is revealed that exhibits the communication and interdependent working practices to support knowledge capture and adaptive learning. Collaborative multidisciplinary communities, whose values reflect local priorities and promote open dialogue and reflection, are featured. The main concern is that the characteristics of bureaucracy; rational-legal authority, a rule-based culture, hierarchical lines of communication and a centralised governance focus, are hindering clinical learning by generating barriers.

Locally emergent collaborative processes are a key strategic resource to capture knowledge, potentially fostering an environment that could learn from failure and translate lessons between contexts. What must be addressed is that reporting mechanisms serve not only the governance objectives, but also supplement learning by highlighting the potential lessons in context. Managers must nurture a collaborative infrastructure using networks in a co-evolutionary manner. Their role is not to direct and design processes but to influence, support and create effective knowledge capture.

Although the study only investigated one site the findings and conclusions may well translate to other trusts--such as the risk of not enabling a learning environment at clinical levels.