Can the Critical Incident Technique Be Used to Reveal and Enable Resilience in Health Care?

In 1954 John Flanagan reported the critical incident technique (CIT) to solve practical problems and develop broad psychological principles optimising performance and procedures. These were initially developed in response to aircraft and aircrew losses during training, at a time before cockpit voice and flight data recorders. The CIT was further developed by its application to a range of industries and professions. The CIT utilises interviews and observations, collecting data with inductive analysis of frequent incidents, identifying behaviours that enable tasks to be performed safely, effectively and efficiently. Flanagan described the CIT in terms of: defining the typical performance (work as imagined) including checklists, observing proficiency of performance (work as done) to identify variations, identifying training requirements, selection of individuals to undertake tasks, job design with elimination of unnecessary tasks, the development and use of operating procedures, using incidents to improve equipment design, motivation and leadership (attitudes, opinions, decisions and choices), and counselling and psychotherapy in response to incidents. We propose the CIT provides a foundation for informing resilient healthcare practices by applying Safety II principles to affect Safety I outcomes. There is consistency with just culture by recognising inter-relationships of recruitment, training and performance, the psychological concepts of behaviours, perception and memory and identification of critical tasks required for key performances to be completed successfully.