Safety-II in complex care: Searching for good examples

Runtime: 2022 – 2023
Client: The Dutch Health and Youth Care Inspectorate (IGJ)

Project description

Since 2021, complex disability care receives extra attention of the Dutch Health and Youth Care Inspectorate (IGJ). Clients of complex care homes have extreme intellectual disabilities and a developmental age between 2 and 4 years old. They often show difficult to understand behavior, as it is hard for them to express their needs. Complex care therefore sets great challenges for care workers and family members.

Although it is not easy to provide appropriate complex care, the IGJ finds that there are institutions that perform well. Whereas one institution requires extra finances to meet clients’ needs, another institution manages to provide a high quality of care without these extra finances. The IGJ questions what causes this discrepancy and what we can learn from practices of good complex care.

IGJ’s supervision is usually risk-based, which means that effective practices are often only noticed by chance. On the contrary, this practice-oriented research program focuses on examples of good complex care: a starting point that finds its origin in the concept of Safety-II. Whereas the more traditional concept of Safety-I emphasizes the importance of noticing and restoring flaws, Safety-II directs our attention towards recognizing what is going well and strengthening good practices.

For this research project, observations and interviews will be done within six care homes of three institutions that perform well according to the IGJ. To understand the process of acquiring and securing good practices, researchers will also attend team meetings and learning sessions. The research team is assisted by a sounding board, existing of carefully selected experts in the field who participate in a personal capacity. By testing if results adequately match practice and if they are scientifically relevant, the sounding board contributes to improving (the supervision on) complex care.


Dr. Erna Scholtes, Jans Berden, prof. dr. Roland Bal, prof. dr. Ian Leistikow

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