Knowledge elicitation for resilience engineering in health care

The Critical Incident Technique (CIT) and the Critical Decision Method (CDM) have been employed successfully to elicit information about human activities, explicate expert knowledge and model decision-making in various domains. Because of their proven efficacy in naturalistic settings, we adapted these methods to develop a script for interviews about resilience in health care. The multi-stage, semi-structured format of the CIT and CDM was adopted as a broad template for the script. However, new questions and probe-types for each stage were created which conformed to the theoretical framework of resilience engineering (RE). Hollnagel's Resilience Analysis Grid (RAG) was used to derive a majority of the probes for each of the capabilities of a resilient organization - monitoring, anticipating, responding and learning. The interview script was iteratively revised based on responses to pilot interviews as well as feedback by human factors and RE experts. The final script was used to successfully interview physician and nurse-providers at various organizational levels and units.