title: Resilience skills as emergent phenomena: A study of emergency departments in Brazil and the United States.
abstract: Although the use of resilience skills (RSs) by emergency department (ED) front-line staff is ubiquitous, the nature and origin of these skills tend to be taken for granted. This study investigates the research question "where do RSs come from"? Case studies in two EDs were undertaken in order to answer the research question: one in Brazil and the other in the United States. The case studies adopted the same data collection and analysis procedures, involving interviews, questionnaires, observations, and analysis of documents. A model for describing RSs as emergent phenomena is proposed. The model indicates that RSs arise from interactions between: work constraints, hidden curriculum, gaps in standardized operating procedures, organizational support for resilience, and RSs themselves. An instantiation of the model is illustrated by a critical event identified from the American ED. The model allows the identification of leverage points for influencing the development of RSs, instead of leaving their evolution purely to chance.
authors.affiliation: DEPROT/UFRGS (Industrial Engineering and Transportation Department, Federal University of Rio Grande do Sul), Av. Osvaldo Aranha, 99, 5. Andar, Porto Alegre, RS, CEP 90035-190, Brazil. Electronic address: priscilawachs@ig.com.br.
authors.forename: Priscila
authors.initials: P
authors.lastname: Wachs
authors.affiliation: DEPROT/UFRGS (Industrial Engineering and Transportation Department, Federal University of Rio Grande do Sul), Av. Osvaldo Aranha, 99, 5. Andar, Porto Alegre, RS, CEP 90035-190, Brazil. Electronic address: saurin@ufrgs.br.
authors.forename: Tarcisio Abreu
authors.initials: TA
authors.lastname: Saurin
authors.affiliation: DEPROT/UFRGS (Industrial Engineering and Transportation Department, Federal University of Rio Grande do Sul), Av. Osvaldo Aranha, 99, 5. Andar, Porto Alegre, RS, CEP 90035-190, Brazil. Electronic address: angelawrighi@yahoo.com.br.
authors.forename: Angela Weber
authors.initials: AW
authors.lastname: Righi
authors.affiliation: University of Florida Health Science Center - Jacksonville, 655 W 8th Street, Jacksonville, FL 32209, USA; Clinical Safety Research Unit, Imperial College London - 10th Floor, QEQM Building, S Wharf Road, Paddington, London W2 1NY, UK. Electronic address: wears@ufl.edu.
authors.forename: Robert Lewis
authors.initials: RL
authors.lastname: Wears
mesh_terms: D001938:Brazil; D003299:Cooperative Behavior; D004636:Emergency Service, Hospital; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008960:Models, Psychological; D019370:Observation; D055500:Resilience, Psychological; D011795:Surveys and Questionnaires; D014481:United States
keywords: Complexity; Emergency department; Resilience engineering; Resilience skills