TRUSTS Technology Integration Inventory: Assessing the Impact of a New Technology on Work System Resilience
Authors: Patterson Emily S. , Neville Kelly J. , Dorton Stephen L. , Barrett Emily , Fersch Theresa , Langone Andrew , Pires Bianica , Rosfjord Kris 
Published: June 2023

We present the Transform with Resilience during Upgrades to Socio-Technical Systems (TRUSTS) Framework, which specifies sources of work system resilience. A work system is defined as elements, including technology, people, policies, protocols, and procedures, that cooperatively function to achieve shared goals. By describing sources of work system resilience, the framework can help a work system’s stakeholders preserve its resilience. This is especially important for high-consequence work systems; these are work systems involved in healthcare, military operations, and national airspace management, as examples. In these work systems, responsivity and adaptivity, i.e., resilience, are requisites to achieving missions and goals in the face of outages and other unexpected events, high demands, and nonroutine conditions. In event-driven environments, system resilience is also required to respond to routine variety produced by uncontrollable aspects of the work, such as treatment responses, weather, and adversary behaviors. The TRUSTS framework is derived from foundational literature in complex systems science and resilience engineering. We build upon prior research in resilience engineering. In that body of work, work system resilience has been defined by Erik Hollnagel and colleagues as based on four cornerstones: anticipating, monitoring, responding, and learning. Its fundamental principles have been described in David Woods’ Theory Graceful Extensibility and writings on complex systems’ adaptive capacity. These cornerstones and principles have typically been described as high-level system capabilities that are illustrated by examples. With TRUSTS, we identify detailed system characteristics and capabilities that afford those high-level cornerstones. The framework is organized into five inter-related factors (a.k.a. the “Big Five” factors) that allow a high-consequence work system and its operations to be responsive and adaptive in the face of challenges. Each of the “Big Five” consists of three to four sub-factors, and each sub-factor consists of two or more resilience requirements. The framework and our associated efforts to operationalize work system resilience are heavily informed by targeted analysis of case studies of new technologies introduced into high-consequence work operations, including healthcare work operations, and interviews with military planning and command and control experts. Currently, we are endeavoring to integrate the TRUSTS Framework into the development of new technologies for health care and other high-consequence work systems. Increasingly, technologies are designed to participate in core work system activities, such as assessment, decision making, planning, and resource brokering and allocation. In these roles, they become integral to the work of other system elements—both technological and human—and the work system as a whole; i.e., they are a part of that work system. When technologies have core roles such as these, they have greater potential to inadvertently interfere with one or more of the means used by the work system to be adaptive and resilient to changing demands and conditions. They also have greater potential to positively contribute to the work system’s resilience. Our goal is to help developers attend to the ways their new technology will impact the work system’s ability to be adaptive and resilient. We present ongoing work to integrate TRUSTS Framework resilience sources into technology development, including newly developed methods and tools that together enable a TRUSTS Resilience-Aware Development (RAD) approach to technology development. The goal of RAD is to help ensure new technologies are designed to contribute to and not unintentionally compromise work system resilience. It ensures technology development benefits both work system efficiency and resilience in the balanced way that is necessary for long-term work system and mission success. Together, the TRUSTS framework and RAD approach and tools can be used to ensure that, as our healthcare work systems become more complex and technology-driven, they maintain the ability to provide responsive patient care and safety that is adaptive to conditions.