Table 2.

Adaptation of Systems Thinking Principles

EUROCONTROL’s 10 system principles for safety	Principles sent as first electronic survey	Number (%) who agreed the principle is important in systems thinking in care n=14	Number (%) who agreed that the wording of this concept makes sense, is unambiguous and understandable n=14	Principles sent as second electronic survey	Number (%) who agreed the principle is important in systems thinking in care n=14	Number (%) who agreed that the wording of this concept makes sense, is unambiguous and understandable n=14	Final principles after adaptation at appraisers’ workshop (note order changed after feedback from appraisers)
The foundation concept: system focus	Foundation principle: system focus	13 (93)	10 (71)	Foundation concept	13 (93)	14 (100)	Foundation concept
Field expert involvement	Field expert involvement	13 (93)	8 (57)	Seek multiple perspectives	13 (93)	14 (100)	Seek multiple perspectives
Local rationality	Local rationality	13 (93)	13 (93)	Understand why decisions make sense at the time	14 (100)	13 (93)	Understand why decisions make sense at the time
Just culture	Just culture	12 (86)	9 (64)
Demand and pressure	Demand and pressure	13 (93)	8 (57)	Consider work conditions	14 (100)	14 (100)	Consider work conditions
Resource and constraints	Resources and constraints	10 (71)	10 (71)
Interactions and flow	Interactions and flows	13 (93)	8 (57)	Analyse interactions and flow	14 (100)	13 (93)	Analyse interactions and flow
Trade-offs	Trade-offs and performance variability	13 (93)	9 (64)	Consider performance variability	14 (100)	14 (100)	Consider performance variability
Performance variability
Emergence	Equivalence and emergence	13 (93)	13 (93)	Explore everyday work	14 (100)	13 (93)	(Removed as application of principles as a whole defines everyday work)
Equivalence

EUROCONTROL, European Organisation for the Safety of Air Navigation.