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Authors/ Year/ (Country)
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Description of RHC
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Methods used to study RHC
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Factors used to develop RHC
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1.
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Gittell 2008 (USA)[21]
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· Organisational resilience … incorporates insights from both coping and contingency theories. It refers to the maintenance of positive adjustment and the ability to flourish or thrive amid adverse conditions when rigidity might otherwise be expected.
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· Archival data.
· Interviews.
· Observations.
· Surveys.
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· Relational coordination between professionals by sharing goals, knowledge and mutual respect.
· Frequent, timely, accurate and problem- solving communication for effective coordination.
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2.
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Mash B, J, et al. 2008 (South Africa)[22]
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· The organisation’s ability to remain true to its core values, competencies and vision rather than invest in a specific structure.
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· Interviews.
· Observations and documentation of changes in progress markers and success of strategies.
· Structured questionnaire.
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· Staff meeting and discussion with an ongoing exchange of ideas and experiences.
· Communication with respect, appreciation and trust.
· Teamwork that enables healthcare professionals to easily interact and commit to each other.
· Effective leadership by sharing the vision, and identifying values.
· Feedback for reflection and learning.
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3.
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Nemeth C, et al. 2011 (USA)[23]
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· The ability of systems to mount a robust response to unforeseen, unpredicted, and unexpected demands and to resume or even continue normal operations.
· Resilience is an emergent property of systems that is not tied to tallies of adverse events or estimates of their probability.
· Studies how people at all levels of an organization try to anticipate paths that may lead to failure, to create and sustain strategies that are resistant to failure, and to adjust tasks and activities to maintain margins in the face of pressure to do more and to do it faster.
· A resilient system can adjust its functioning prior to, during, or following changes and disturbances so that it can sustain required operations, even after a major mishap or in the presence of continuous stress.
· The notion of resilience frees safety research from hindsight bias by making it possible to understand how workers anticipate possible adverse outcomes and act in advance to avert them.
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· Observational study.
· Cognitive task analysis.
· Interviews.
· Artefact analysis.
· Work domain analysis.
· Process tracing.
· Rapid prototyping.
· Evaluation.
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· N/A
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4.
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Ross A, et al. 2012 (UK)[24]
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- The capacity of a system to adapt safely to changing conditions. Resilience can be defined as the ability of a system to self-correct and adapt to disturbances so that normal operations can be maintained even when unexpected conditions are encountered.
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· Interviews.
· Cognitive task analysis.
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· Understanding the nature of the gap and how front-line practitioners bridge it and sometimes fail.
· Specialist team to coordinate decision making for various medical conditions that open a line for education, detecting problems and managing them early.
· Good feedback, communication and monitoring.
· Updating knowledge.
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5.
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Crowe S, et al. 2014 (UK)[25]
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· The capability of a health system to mitigate the impact of major external disruptions on its ability to meet the needs of the population during the disruption.
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· Computer software modelling tool to assess resilience.
· Optimisation and heuristic methods to capture response.
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· N/A
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6.
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Drach-Zahavy A, et al. 2015 (Israel)[26]
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· Identify, correct and ‘bounce back’ from errors, with obvious positive consequences for patient’s safety.
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· Observations.
· Data extraction from patient’s chart.
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· Face to face communication between healthcare professionals and non-professional workers with patients.
· Interactive discussion between incoming and outgoing healthcare professionals that enhances safety through situational awareness.
· Exposure to a diversity of opinions.
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7.
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Anderson JE, et al. 2016 (UK) [27]
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· The ability of the health care system to adjust its functioning prior to, during, or following events (changes, disturbances, and opportunities), and thereby sustain required operations under both expected and unexpected conditions.
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· CARE model.
· Observation.
· Interviews.
· Document analysis.
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· N/A
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8.
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McCray J, et al. 2016 (UK)[28]
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· Team Resilience is a team’s ability to “bounce back” and “maintain” performance under adverse circumstances. Performance is the team outputs and delivery, and in the case of integrated teams in the health and social care sector, is likely to be linked to service user outcomes.
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· Focus groups.
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· Effective teamwork.
· Team relationship.
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9.
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Back J, et al. 2017 (UK)[29]
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· The intrinsic ability of a health care system to adjust its functioning prior to, during, or following events (changes, disturbances and opportunities), and thereby sustain required operations under both expected and unexpected conditions.
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· CARE model.
· Analysis of escalation policies.
· Observations.
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· Team work structure.
· Awareness of the state of the hospital system based on experience and expertise.
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10.
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Rosso C, et al. 2018 (Brazil)[30]
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· The ability of the healthcare system to adjust its functioning prior to, during, or following changes and disturbances, so that it can sustain required performance under both expected and unexpected conditions.
· Resilience in healthcare … shed light on the gap betweenWAI and WAD, as well as on new approaches for patient safety, which rely on learning from every day work, instead of only from adverse events.
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- FRAM.
- Notes from observations, focus groups and other documents.
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· Creation of conditions to design and construct systems that have the capacity of resilience.
· Modelling designs by developing innovative artefact to solve practical problems and make scientific contribution.
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11.
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Wahlström M, et al. 2018 (Finland)[31]
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· The intrinsic ability of a system to adjust its functioning prior to, during, or following changes and disturbances, so that it can sustain required operations under both expected and unexpected conditions.
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- Core-task analysis.
- Action-perception-cycles.
- Observations.
- Video analyses.
- Interviews.
- Self-confrontation video sessions.
- Workshops.
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· Mindfulness characterises: anticipation, backups, holistic consideration of patient anatomy, and thoughtful damage minimisation.
· Technical developments and medical knowledge.
· Situational interpretation.
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12.
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Cuvelier L, et al. (France)[32]
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The intrinsic ability of a system to adjust its functioning so that it can sustain required operations under both expected and unexpected conditions.
- It is not only the system’s ability to cope with unforeseen variability that fall outside the expected areas of adaptations, but also looks at its ability to operate in foreseen conditions.
- A resilient system is the one capable to detect that the conditions have changed, to assure transition to another state and to operate in the new state of resilience achieved.
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- Open-observations.
- Incidents.
- Interviews.
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- Care protocols.
- Experience.
- Making situations more predictable.
- Increase knowledge.
- Vocational training.
- Cognitive trade-off.
- Mobilisation of additional resources.
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13.
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Pariès J, et al. (Switzerland)[33]
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- The ability to make sacrificing decisions, such as accepting failures to reach an objective in the short term to ensure another long-term objective, or ‘cutting one’s losses’ by giving up initial ambitions to save what is essential.
- The ability to acknowledge the need to shift from one mode to the other. It measures the quality and robustness of trade-offs; their stability in the presence of disturbances.
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- Anticipation capacity.
- Skills and accuracy of team’s perception.
- Trade-offs.
- Diversity of experiences.
- Interactions with patients.
- Intuition.
- Sacrificing decisions.
- Functional reconfiguration.
- Collaboration between different job profiles.
- Strong team spirit.
- Leadership mechanisms.
- Flexible delegation.
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14.
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Laugaland K, et al. (Norway)[34]
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- The ability of healthcare system to succeed under varying conditions to increase the proportion of intended and acceptable outcomes.
- Adjustments could be deemed successful from one perspective but not from the viewpoint of others.
- Different outcomes thus represent different judgement of values that need to be explored and acknowledged in order to be able to share a common ground on what constitutes acceptable, successful outcomes.
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- Multi-faceted outcomes from different perspectives.
- Interconnections between systems.
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15.
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Stephens RJ, et al. (USA)[35]
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Capacity for maneuver.
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· Observations.
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- Coordinate adaptive capacities across units.
- Regulate the capacity for manoeuver.
- Reduce the risk of decompensation in hospital units.
- Reciprocity.
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16.
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Anderson JE, et al. (UK)[36]
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- The ability of the health care system to adjust its functioning prior to, during, or following events (changes, disturbances and opportunities), and thereby sustain required operations under both expected and unexpected conditions.
- … ability or capacity for adaptation, rather than a state of the system.
- Understands the complexities of the whole system rather than focuses on a discrete part.
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- Interpretive approach.
- Observations.
- Interviews.
- CARE model.
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- Balance different goals during discharge process.
- Plan and co-ordinate the different tasks for discharge across different staff groups, agencies, and families and carers.
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17.
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Debono D, et al. (Australia)[37]
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Adapt, flex and navigate competing demands so as to adjust under expected or unexpected conditions in order to sustain required operations.
- The shifting and jostling demands of delivering care that prioritise one goal over another in a continually changing way, the role of context in influencing that process, and ongoing judgements about when to use [or not use] primary and secondary workarounds.
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- Comparing WAI (process mapping) with WAD (observations, interviews and focus groups).
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18.
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Deutsch E, et al. (Unstated)[38]
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- Reinforcing appropriate actions and resources making the margins and constraints of the system visible, and developing team behaviours that have the potential to improve the adaptive capacity of the team.
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- Simulation.
- NASA-TLX score.
- Debriefing.
- Analyse the simulation performance from the perspective of four abilities for resilience.
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19.
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Furniss D, et al. (UK)[39]
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- It can adjust its functioning prior to, during, or following events (changes, disturbances, and opportunities), and thereby sustain required operations under both expected and unexpected conditions.
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- RMF.
- Semi-structured interviews.
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- Provide an alternative means for clinicians to access relevant medical information.
- Take time for mental preparation.
- Take drugs and equipment to emergency calls.
- Maximise information extraction.
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20.
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Heggelund C, et al. (Norway)[40]
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- Theoretical framework using the four cornerstones of resilience: anticipation, monitoring, learning, and response.
- Qualitative interviews, focus group interviews, field notes from observations (meso and micro level) and analysis of national documents (macro level).
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- Identify the content and evaluate the variability in the four cornerstones of resilience.
- Flexible organising.
- Cultural factors (openness, support, communication, cohesion and trust).
- Mixing experienced and inexperienced people.
- Knowledge and experience.
- Buffer of staff familiar with the services.
- Procedures and the use of checklists and protocols.
- Simulation.
- Multi and inter disciplinary training.
- Teamwork.
- Statistics available for employees.
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21.
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Horsley C, et al. (New Zealand)[41]
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- The ability of the health care system to adjust its functioning prior to, during or following events (changes, disturbances, opportunities) and thereby sustain required operations under both expected and unexpected conditions.
- The ability to adapt over multiple timescales that marks the concept of resilience as different from concepts of robustness or rebound, in which temporary stressors on the system (i.e., patient admissions, acute events, disasters) must be absorbed without overt failure.
- RHC should expand its aspiration beyond safety or even ‘sustaining operations’ to seeing the potential for this approach to advance health care towards the long-held goals of safe, patient-centred care delivered by engaged staff.
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- Team Resilience Framework.
- Simulation.
- Interviews and in-practice observations.
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- Shared understanding of current situation.
- Allocate or self-nominate roles to team staff.
- Efficient communication.
- Explicit about expectations.
- Know what to monitor.
- Flexible response to events.
- Learn why things go right.
- Open and productive team climate.
- Debriefings.
- Checklists.
- Team training.
- Human factors teaching.
- Shared team concept.
- Psychological safety.
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22.
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Hounsgaard J,et al. (Denmark)[42]
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23.
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Hunte G, et al. (Canada)[43]
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- The ability of a system to adjust its functioning prior to, during, or following events (changes, disturbances and opportunities), and thereby sustain required operations under both expected and unexpected conditions. Central to this proactive approach is the understanding that safety is dynamic, emerges from everyday practice, and is something a system does.
- In a resilient system, large increases in work processed contribute to only small increases in recovery, and the system is able to keep pace.
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- Team-environment.
- Exploitation of resources.
- Systematic (re)prioritisation.
- Effective linkages, communication and attention to cross-scale interactions.
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24.
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Nakajima K, et al. (Japan)[44]
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- Direct and indirect approaches to represent WAD (minutes and memoranda of hospital committees, medication supply data, observations, interviews, and expert opinions).
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- Resource allocation.
- Systemic approach.
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25.
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Ross A, et al. (UK)[45]
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- CARE model.
- Interviews using cognitive task analysis techniques.
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- Inpatient care cycle.
- Workarounds and outcome trade-offs.
- Distributing expertise at the ward level.
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26.
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Sujan M, et al. (UK)[46]
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- RHC is able to reconcile the gap between the way everyday clinical work unfolds WAD with the way managers and administrators think about clinical practice WAI.
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- Process map and FMEA.
- FRAM.
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- Communication and building trust between stakeholders.
- Proactive and mindful.
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27.
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Zhuravsky L, (New Zealand)[47]
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- The ability of the health care system to adjust its functioning prior to, during, or following events (changes, disturbances and opportunities), and thereby sustain required operations under both expected and unexpected conditions.
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- Autoethnographic methodology.
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- Leadership (individual and shared).
- Simulation and debriefings.
- Training.
- Workarounds.
- Proactive monitoring of signs of stress, fatigue and anxiety.
- Utilise technical capabilities.
- Handovers.
- Double-loop approach to learn.
- Realignment of WAI with WAD.
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