Exploring the resilience potentials of a responsive team managing clinical deterioration: A systems analysis

Clinically deteriorating patients require timely care to prevent harm. This study examines how a responsive team delivers resilient care via the Rapid Response System (RRS) by analysing the four resilience potentials (anticipating, monitoring, responding, and learning). Using an integrated Systems Thinking for Everyday Work (STEW) and Functional Resonance Analysis Method (FRAM) approach, we investigated functional interdependencies and sensemaking through documentary analysis, non-participant observations, and semi-structured interviews. Three system conditions (limitations in clinical tools, misalignment between technology and user needs, and resource constraints) shaped how resilient performance addressed coordination and communication challenges to maintain patient flow and safety. Unique to responsive teams, awareness of operational boundaries and experience influenced how adaptations unfolded across system levels. While some adaptations supported safe care, others led to non-value-added activities. The findings show how resilience potentials and hidden adaptations can inform leading safety indicators and system improvement through a human factors and design perspective.