Learning Resource

Introduction to systems-based investigations in healthcare

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About this Learnng Resource

Type: video lecture

Audience: Learners with roles in healthcare safety investigation, including investigation, commissioning, oversight and involvement.

Duration: 8 mins

Objectives: By the end of this resource, you will be able to:

  1. Describe what is meant by a systems-based investigation.
  2. Justify the use of systems-based frameworks to support analysis.
  3. Discuss the principles of counterfactual reasoning and local rationality.

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Competency mapping

Includes introduction to the following competencies [1]:

  • 4.2 Understands the fundamentals of a systems approach, investigation methodologies and methods, and of engaging people.
  • 17.1 Understands systems thinking and why it is needed within investigations in complex healthcare systems.
  • 18.5 Counterfactual reasoning (what could or should have happened) is not the final outcome of an investigation; the focus is on understanding the work system.
  • 18.6 Exploring local rationality (the influence of situation and context on decisions and actions) is key to understanding why work differs from what was expected.

[1] Lim, R., Hide, S., et al. (2026) Development of a competency framework for healthcare safety investigators: a modified e-Delphi study. Safety Science, 198, 107161. DOI: 10.1016/j.ssci.2026.107161

Further reading

Key images

Varieties of human work

A conceptual diagram showing different ways of understanding how work is carried out in practice. At the centre is a large green circle labelled “Work-as-Done”, representing the reality of how work is performed. Four smaller blue circles surround it and are connected to the centre by lines. These are: Work-as-Imagined (top) Work-as-Prescribed (right) Work-as-Observed (bottom) Work-as-Disclosed (left) A green dotted box labelled “Interviews and focus groups” is linked to Work-as-Disclosed, indicating that this perspective is gathered through conversations with staff. A second green dotted box labelled “Observation of practice” is linked to Work-as-Observed, showing that this perspective comes from watching work being carried out. A blue dotted box in the lower left corner lists other ways of approximating work-as-done: Work-as-Judged, Work-as-Measured, Work-as-Instructed, Work-as-Simulated, and Work-as-Analysed.

Adapted from Humanistic systems – The varieties of human work

CARe-QI

A flow diagram with three sections. On the left, a dashed green box labelled Work as Imagined contains two blue boxes: Demand above Capacity, connected by arrows labelled Alignment. In the centre, a blue-green box labelled Adaptations Adjustments sits above the words Work as Done, with arrows linking it to Demand and Capacity. On the right, a dashed green box labelled Outcomes contains a green box labelled Successful/acceptable above a blue box labelled Unsuccessful/unacceptable. Arrows connect the central box to both outcome boxes. Additional arrows run across the top and bottom of the diagram, linking the left and right sections.

Adapted from Monash University – CARe-QI: a handbook for improving quality through resilient systems