A mixed methods case study of a rapid response system in Wales: learning from resilient care and outcomes for safety improvement

Ganasan-Ryan, Shalini 2025. A mixed methods case study of a rapid response system in Wales: learning from resilient care and outcomes for safety improvement. PhD Thesis, Cardiff University. Item availability restricted.

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Abstract

Resilient healthcare (RHC) is an emerging approach to understanding healthcare system safety but remains underdeveloped in understanding the work of responsive teams. The Patient at Risk Team (PaRT) is one such team that rescues deteriorating patients through the Rapid Response System (RRS). This study uses the RRS as a case to examine the triggers and factors that support resilient care. It explores how learning from events and factors leading to different types of outcomes can inform safety improvements. This thesis aims to develop an empirically grounded theoretical model of resilience for the RRS setting. A convergent, parallel mixed methods case study was conducted, incorporating documentary analysis, non-participant observations, semi-structured interviews, and focus groups. The RRS was modelled using a Work Domain Analysis to illustrate systemic constraints. The Functional Resonance Analysis Method was used to visualise functional interdependencies that influence adaptive capacity, a key element in RHC and safe care. The resilience model was developed a priori informed by the integrative literature review and sensemaking theory and refined through empirical research. The main theoretical contributions emphasise teamwork as crucial for resilient performance, mapping the RHC literature to relevant teams studied and developing a learning map alongside a resilience model. Methodologically, this thesis introduces a novel data collection tool and integrates various modelling techniques to enhance RHC understanding. A 2x2 matrix, categorised by event type and impact, alongside a five-step sensemaking process, served to reduce uncertainty, support strategic decision-making, and foster resilient performance. Insights from outcome analysis revealed the role of human factors in improving safety, the benefits of a psychologically safe environment for learning, and the overall value of relational leadership. In conclusion, the thesis makes novel contributions to the literature on RHC by integrating both theoretical and practical perspectives. Furthermore, it provides in-depth insights into the learning component of RHC, which is currently underspecified.

Item Type:	Thesis (PhD)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Business (Including Economics)
Date of First Compliant Deposit:	15 December 2025
Last Modified:	15 Dec 2025 16:55
URI:	https://orca.cardiff.ac.uk/id/eprint/183241

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