On the brink: Identifying, integrating and responding to the early warnings of organisational failure

University of Oxford

  • Project led by the University of Oxford and supported by the Health Foundation’s Policy Challenge Fund.
  • Focuses on how to detect and respond to the early signals of failures in health care, before risks develop into major failures.
  • Will review a wide range of relevant literature and interview people with practical experience of detecting failure and managing risk in different industries where reliability is crucial: for instance transport, critical infrastructures and financial services. 

After major health care failures, such as failures of safety and quality in Mid Staffordshire and serious financial failures in South London, inquiries often point to a litany of early warnings that were missed, misunderstood or discounted. This project will examine practices, principles and policies in a range of sectors to understand how early warnings might best be monitored and proactively acted on, in order to inform future health policy.

The project, will address four policy challenges:

  • How can an integrated oversight system be designed to monitor and detect the early signs of serious failures as they emerge across the healthcare system?
  • What are the key characteristics of early warnings and indications of developing failure, and how can these be routinely identified and integrated?
  • How can early signs of failure be proactively responded to in constructive and coordinated ways?
  • What are the best approaches that could be used to intervene at an early stage to avert the occurrence of major failures in the NHS?

These challenges are also faced in other sectors, and different industries have developed a range of approaches to detecting and responding to the early signs of failure. The project will draw on relevant literature, theory and experience from other sectors and health care systems. It will develop practical insight to support national and local systems in how they identify and manage quality and financial risks.

The project is due to be complete by December 2016.

Contact details

For more information, please contact Carl Macrae, Senior Research Fellow, Department of Experimental Psychology, University of Oxford. 

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