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Ruth Baxter

Dr Ruth Baxter

Area of study
Patient safety
Fellowship level
Year awarded
Host university
School of Psychology
University of Leeds
Ruth has a background in Psychology and completed her PhD in Improvement Science. She has worked in the Yorkshire Quality and Safety Research group since 2016 and her research interests include Safety-II/Resilient Health Care, the positive deviance approach, patient involvement, and transitions of care.
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Moving from theory to practice: Operationalising Resilient Health Care to improve patient safety


Attempts to improve patient safety typically focus on identifying and then reducing the causes of error and harm. This approach, now termed ‘Safety-I’, has had limited success, in part because patient safety theories have been misinterpreted and poorly applied.

Over the past decade, ‘Safety-II’ and Resilient Health Care (RHC) theory have emerged as a new approach to managing patient safety. RHC recognises that things typically go right and so seeks to support performance within an acceptable boundary. However, little is known about how RHC theory can be translated into practice.

This project explores how RHC theory can be embedded within the practical tools and approaches used to improve patient safety. By ensuring that RHC is not ‘lost in translation’ we will increase the chances of it successfully improving patient safety in the future.


This project aims to produce guidance that:

  • defines the principles of safety improvement via RHC,
  • illustrates how these can be operationalised,
  • and addresses the complexities of applying RHC in practice.

Initially, existing literature will be reviewed to define the core principles that underpin RHC approaches to safety improvement. Following this, two studies will explore how these core principles align (or conflict) with current approaches to improving safety. The studies will also explore how these core principles can be applied in practice – either by adapting what is currently done, or by doing things in new ways.

The first study explores stakeholder perspectives including those of academics, policy makers, patients, and clinicians. The second study involves working as an embedded researcher alongside staff within a maternity unit. The studies will be conducted in parallel so that theoretical issues can be explored in practice and vice-versa.

Ruth gave a lightning talk related to her research project at our 2021 annual event, THIS Space:

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