A human factors and reliability approach to clinical risk management: Evidence from Italian cases

Similarly to the industrial sector in the late 1980s, nowadays leading organizations in the healthcare sector acknowledge the fact that human errors, adverse events and system failures must be managed and controlled. Whilst Human Reliability Analysis (HRA) has been well-accepted and integrated into safety management processes in other industries, the application of such error techniques to the problem of managing the associated risks in healthcare is rare. The main purpose of this research is to analyse clinical risk management (CRM) and patient safety improvement in Italian healthcare organizations, through human factors and human reliability theories. In particular, the specific objectives are to explore the Italian state-of-the-art in CRM, with regard to organizational and managerial issues; to identify and verify the factors influencing the growth and sharing of the safety culture and to understand and describe the possibility of transferring human reliability methodologies and theories to the domain of healthcare.Six case studies belonging to the Italian scenario have been performed, in order to describe the Italian healthcare system and to identify the key influencing factors of CRM policies.Results obtained from within and cross-case analysis give an empirical contribution to the recent introduction of CRM in the Italian context and a theoretical contribution referring to the framework used to analyse CRM in healthcare organizations, and to the indications which emerged on the key factors influencing CRM.     

Measuring safety culture in healthcare: A case for accurate diagnosis

Recent concern regarding the safety of patients in Western healthcare systems has resulted in the adoption of safety management techniques used in high-risk industries. One such method is the use of safety climate questionnaries to survey workforce perceptions and attitudes towards both worker and patient safety in healthcare organizations. Many of the earliest healthcare safety climate measures did not appear to meet accepted psychometric standards. The theoretical foundation of the relationship between perceptions of safety climate and workers’ behaviour is not well specified in this literature and a model derived from industry research is proposed.     

Weighing the pig never made it heavier: Auditing OHS,social auditing as verification of process in Australia

South Australian organizations assess their OHSMS through audits as evidence of risk control and to help make workplaces healthy and safe. Auditing is an evaluative process regarded as an important step in the cycle of continuous improvement in OHS. Auditing began with financial audits conducted for reasons of corporate governance: for accountability, to inform management decisions and to provide market confidence. Society expects audits to be a tool of regulation, governance and accountability, but celebrated failures of audits to warn of impending financial collapse in organizations in recent years appears to have led to an increased fervour for auditing, rather than a decline. Social audits, including auditing of OHSMS, are intended to determine that an organization is meeting its corporate social responsibilities; but what is audited is often contested and requires subjective analysis. Financial and social audits are subject to failure: unintentional errors, deliberate fraud, financial interests causing undue influence, and undue influence from personal relationships between the auditor and client. We identify five further categories of failure: lack of worker participation; paperwork for the sake of the audit; goal displacement of audit scoring; confusion of audit criteria; and lack of auditor independence and skill. There has been a shift in focus: the current demand and preparation for auditing distracts organizations from the primary goal of making the workplace healthy and safe. We argue that auditing OHSMS has become a ritual rather than a means of improving workplace health and safety and should at least be treated with caution.     

社会组织参与下的职业健康治理模式分析与研究

针对现阶段政府监管主导下的职业健康治理模式存在的不足,从社会组织的角色定位、社会组织参与下的职业健康治理体系构成与运行机制等方面提出建议,并以目前多个地方现行的社会组织参与下的职业健康治理实践工作为例,对相关治理模式进行分析与总结,本文所提出的社会组织参与下的治理模式可以为各级政府和企业进一步提高相关职业健康治理水平提供参考和借鉴。     

Identifying common problems in the acquisition and deployment of large-scale,safety–critical,software projects in the US and UK healthcare systems

Public and private organisations are investing increasing amounts into the development of healthcare software. These applications are perceived to offer numerous benefits. Software systems can improve the exchange of information between healthcare facilities. They support standardized procedures that can help to increase consistency between different service providers. Electronic patient records ensure minimum standards across the trajectory of care when patients move between different specializations. Healthcare information systems also offer economic benefits through efficiency savings; for example by providing the data that helps to identify potential bottlenecks in the provision and administration of care. However, a number of high-profile failures reveal the safety concerns that arise when staff must cope with the loss of these applications. In particular, teams have to retrieve paper based records that often lack the detail of electronic systems. Individuals who have only used electronic information systems face particular problems in learning how to apply paper-based fallbacks. The following pages compare two different failures of healthcare information systems in the UK and North America. The intention is to ensure that future initiatives to extend the integration of electronic patient records will build on the ‘lessons learned’ from previous systems.     

High‐quality relationships,psychological safety,and learning from failures in work organizations

How can organizations support employees to engage in learning from failures? In this paper, we draw on the concept of high‐quality relationships to explore the relational underpinnings of learning from failures in organizations. We focus on relational coordination as a specific manifestation of high‐quality relationships and examine how the relational dimensions of relational coordination—shared goals, shared knowledge, and mutual respect—foster psychological safety and thus enable organizational members to engage in learning from failures. The results of two separate studies support our mediation model where psychological safety mediates the link between high‐quality relationships and learning from failures in organizations. Copyright © 2008 John Wiley & Sons, Ltd.     

Fuzzy dynamic risk-based maintenance investment optimization for offshore process facilities

A methodology for maintenance planning is developed which helps in improving the reliability of the components and safety performance in process facilities. This methodology helps design an optimum safety maintenance investment plan by integrating the optimization techniques and a fuzzy dynamic risk-based method. Intuitionistic Fuzzy Analytic Hierarchy Process (IFAHP) is applied to deal with uncertain data. The proposed approach employs multi-experts’ knowledge which helps to optimize the maintenance investments. A separator system in an offshore process facility platform is selected as a case study to demonstrate the application of the proposed methodology. A practical example in the separator system is surveyed and potential failures and Basic Events (BEs) are identified. Finally, a risk-based maintenance plan is provided for future safety investment analysis. The results indicate that the developed methodology estimates the risk more accurately, which enhances the reliability of future process operations.     

The context and habits of accident investigation practices: A study of 108 Swedish investigators

The context and habits of accident investigation practices were explored by means of questionnaire data obtained from accident investigators in the healthcare, transportation, nuclear and rescue sectors in Sweden. Issues explored included; resources, training, time spent in different phases of an investigation, methods and procedures, beliefs about causes to accidents, communication issues, etc. Examples of findings were: differences in the extent to which the ‘human factor’ was perceived as a dominant cause to accidents; manning resources to support investigations were perceived as rather scarce; underutilization of data from safety related processes such as risk analysis and auditing data; the phase of suggesting remedial actions (recommendations) were comparatively brief and generally not well supported. A majority of the investigators thought that the investigations were free from pressures to follow a specific direction; the investigators also thought that performing an investigation in itself (regardless of the specific results) had positive influences on safety. A majority of the investigators thought that upper management had a relatively strong influence on safety in the organizations. The results are discussed in terms of suggestions for strategies to strengthen investigation practices – particularly those conducted as part-time work in organizations.     

A methodology for evaluation and monitoring of recurring hazards in underground coal mining

This study provides a methodology for evaluation and monitoring of recurring hazards in underground coal mining. An important measure in this regard may be the ‘time between occurrences’ (TBO) of hazards that can be modeled in the similar fashion of ‘time between failures’ (TBF) data modeling which is practiced in reliability study. Typically, time between accidents is modeled in safety study. This study is therefore new in two counts: (i) statistically modeling hazard occurrences based on inspection reports and (ii) monitoring of safety status based on control charting of hazard occurrences. The methodology includes Weibull-distribution based hazard rate functions, Poisson-distribution based cumulative risk functions, and Weibull-distribution based control charts. The new methodology is applied to an underground coal mining worksystem and the results are discussed. The case study results show that hazards related to machinery, ground-fall, housekeeping, roadways, and materials are more frequently occurring. It is recommended that in addition to planned inspections for identification of hazards, a control chart based hazard mitigation scheme should be employed at the mine sections for better monitoring and control of hazards.     

公共危机管理中的组织学习研究

目前国外对危机管理的研究已经趋于成熟,已经进一步提出了在危机中学习的概念并取得一些进展。而在经历了几次大的危机之后,国内学者开始关注公共危机管理。随着危机种类越来越多,发生频率越来越高,政府的公共部门必须要具备组织学习的能力。但是国内对于组织学习研究在公共管理领域的延伸还十分有限,我国仅少量学者探讨了学习型政府,对其它类型公共部门的组织学习研究则更为罕见。显然,这种研究的缺失不利于公共组织构建组织学习能力和提高服务水平。未来的国内学习型组织研究需要在公共组领域有所突破,特别是危机情境下的公共组织学习。因此本文以分析文献的方式,借鉴国内外学者对公共危机管理,以及组织学习的研究,希望能为公共部门组织学习的深层探索提供思路。     

ISO22320：2011《公共安全-应急管理-事故响应要求》国际标准解读

本文主要介绍了ISO22320：2011国际标准的作用、使用范围和内容,重点强调了指挥和控制的要求、操作信息的需求、合作与协调的要求等,以为我国应急管理及其相关组织实施该国际标准提供帮助。     

Seeking to improve care for young patients: Development of tools to support the implementation of the CDC Pediatric mTBI Guideline

IntroductionThe Centers for Disease Control and Prevention (CDC) Pediatric Mild Traumatic Brain Injury (mTBI) Guideline was created to help standardize diagnosis, prognosis, and management and treatment of pediatric mTBI. This paper describes the process CDC used to develop educational tools, and a dissemination and implementation strategy, in support of the CDC Pediatric mTBI Guideline.MethodsTwo qualitative data collection projects with healthcare providers who care for pediatric patients were conducted. In-depth interviews were used in both projects. Project One examined healthcare providers' guideline use and dissemination preferences. Project Two assessed perceptions of the CDC Pediatric mTBI Guideline educational tools.ResultsProject One brought to light four key areas related to Guideline usage and dissemination preferences, specifically a need for: (1) partnership with professional medical societies; (2) integration into electronic health records, mobile apps, and websites; (3) development of continuing medical education (CME) opportunities; and (4) dissemination through healthcare system leadership. In Project Two, healthcare providers reported that the CDC Pediatric mTBI Guideline educational tools were well-organized, clear and easy to navigate, and informative. Healthcare providers also requested more information on the Guideline methodology.DiscussionAssessment of pediatric healthcare providers' current use of clinical guidelines and preferences for educational tools yielded important insights that helped inform CDC's dissemination and implementation strategy for the Pediatric mTBI Guideline.Practical applicationsThe findings from these data collection projects can also inform other guideline implementation and dissemination efforts among healthcare providers.     

Development of a risk-based maintenance (RBM) strategy for a power-generating plant

The unexpected failures, the down time associated with such failures, the loss of production and, the higher maintenance costs are major problems in any process plant. Risk-based maintenance (RBM) approach helps in designing an alternative strategy to minimize the risk resulting from breakdowns or failures. Adapting a risk-based maintenance strategy is essential in developing cost-effective maintenance policies.The RBM methodology is comprised of four modules: identification of the scope, risk assessment, risk evaluation, and maintenance planning. Using this methodology, one is able to estimate risk caused by the unexpected failure as a function of the probability and the consequence of failure. Critical equipment can be identified based on the level of risk and a pre-selected acceptable level of risk. Maintenance of equipment is prioritized based on the risk, which helps in reducing the overall risk of the plant.The case study of a power-generating unit in the Holyrood thermal power generation plant is used to illustrate the methodology. Results indicate that the methodology is successful in identifying the critical equipment and in reducing the risk of resulting from the failure of the equipment. Risk reduction is achieved through the adoption of a maintenance plan which not only increases the reliability of the equipment but also reduces the cost of maintenance including the cost of failure.     

Application of game theory in risk management of urban natural gas pipelines

This paper presents a game theory methodology for risk management of urban natural gas pipelines, which is a collaborative participation mechanism of the stakeholders, including government, pipeline companies, and the public. Firstly, the involvement proportion of stakeholders in risk management under rational conditions is estimated by the static game theory. Subsequently, the system dynamics (SD) simulation is used to establish an evolution game model of stakeholders in risk management under the irrational conditions, in which the stability of the evolution game process is analyzed. The stakeholders’ involvement proportions from the static game model are utilized as the inputs for the evolution game model to simulate the dynamic evolution behavior of risk management strategies with different involvement proportions of stakeholders. Eventually, the dynamic evaluation game can extract an optimal strategy for risk management of urban natural gas pipelines. A case study is used to illustrate the methodology. In essence, this methodology can be extended for implementing risk management of urban infrastructure.     

Professional diversity,identity salience and team innovation: The moderating role of openmindedness norms

The impact of diverse composition in teams is neither straightforward nor direct, and evidence suggests that diversity can be either conducive or detrimental to team innovation. Professionally diverse healthcare teams are increasingly used to develop innovative clinical approaches and solve complex healthcare problems; however, there is evidence that collaboration across professional boundaries creates conflict and is frequently unsuccessful. Healthcare organizations consequently face a dilemma. If they embrace professional diversity in teams, they risk interprofessional hostility, but if they choose homogeneous teams, they diminish their teams' capacity to innovate. We respond to this quandary by utilizing social identity theory to better understand the mechanisms through which professional diversity can enhance team innovation. In particular, we argue that professional identity salience operates as a mediator capable of explaining both positive and negative outcomes of professional diversity, contingent on the moderating effect of openmindedness norms. Analysis of survey data from 70 healthcare teams supports our model and indicates that professional salience can both enhance and undermine team innovation, depending on the extent of team openmindedness. Copyright © 2015 John Wiley & Sons, Ltd.     

Critical Success Factors for Behavior-Based Safety: A Study of Twenty Industry-wide Applications

One-on-one interviews and focus-group meetings were held at 20 organizations that had implemented a behavior-based safety (BBS) process in order to find reasons for program success/failures. A total of 31 focus groups gave 629 answers to six different questions. A content analysis of these responses uncovered critical information for understanding what employees are looking for in a BBS program. A perception survey administered to individual employees (n = 701) at these organizations measured a variety of variables identified in prior research to influence success in safety efforts. The survey data showed five variables to be significantly predictive of employee involvement in a BBS process: 1) perceptions that BBS training was effective; 2) trust in management abilities; 3) accountability for BBS through performance appraisals; 4) whether or not one had received education in BBS; and 5) tenure with the organization. Also, employees in organizations mandating employee participation in a BBS process (n=8 companies) reported significantly higher levels of: (a) involvement; (b) trust in management; (c) trust in coworkers; and (d) satisfaction with BBS training than did employees whose process was completely voluntary (n = 12 companies). In addition, employees in mandatory processes reported significantly greater frequency of giving and receiving positive behavior-based feedback.     

Macroergonomic Analysis and Design for Improved Safety and Quality Performance

Abstract

Macroergonomics, which emerged historically after sociotechnical systems theory, quality management, and ergonomics, is presented as the basis for a needed integrative methodology. A macroergonomics methodology was presented in some detail to demonstrate how aspects of microergonomics, total quality management (TQM), and sociotechnical systems (STS) can be triangulated in a common approach, in the context of this methodology, quality and safety were presented as 2 of several important performance criteria. To demonstrate aspects of the methodology, 2 case studies were summarized with safety and quality performance results where available. The first case manipulated both personnel and technical factors to achieve a “safety culture” at a nuclear site. The concept of safety culture is defined in INSAG-4 (International Atomic Energy Agency, 1991). as “that assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety issues receive the attention warranted by their significance.” The second case described a tire manufacturing intervention to improve quality (as defined by Sink and Tuttle, 1989) through joint consideration of technical and social factors. It was suggested that macroergonomics can yield greater performance than can be achieved through ergonomic intervention alone. Whereas case studies help to make the case, more rigorous formative and summative research is needed to refine and validate the proposed methodology respectively.     

Determinants of salaries earned: Comparisons of black and white healthcare managers

We develop and test a model of salaries attained for four groups of healthcare executives: white males (n=216); black males (n=124), white females (n=249) and black females (n=139). We show that blacks are not earning as much as whites and that females of either race are earning less than males. Three sets of predictors are evaluated: individual achievements; access to employment by certain types of healthcare organizations; and treatment within the employing organization. Individual attainments, such as years of experience, predict higher salaries in all four groups. Only black males benefit from having taken a specialized degree in healthcare management. Also, supervision of whites within the employing organization raises the salaries of all groups except white females. Hospital employment, and private-sector employment play only an indirect role in salaries achieved by blacks in this 1991 survey.     

城市社区风险治理若干问题探讨

为提升社区风险治理水平,本文阐述了社区与社区风险的概念,分析了社区风险的复杂性和多样性,探讨了提升社区风险治理水平的几个关键问题。结果表明:社区居民参与、网格化管理、科技支撑和法制建设是提升社区风险治理水平的关键。