On the brink of disruption: Applying Resilience Engineering to anticipate system performance under crisis.

As COVID-19 spread across Brazil, it quickly reached remote regions including Amazon's ultra-peripheral locations where patient transportation through rivers is added to the list of obstacles to overcome. This article analyses the pandemic's effects in the access of riverine communities to the prehospital emergency healthcare system in the Brazilian Upper Amazon River region. To do so, we present two studies that by using a Resilience Engineering approach aimed to predict the functioning of the Brazilian Mobile Emergency Medical Service (SAMU) for riverside and coastal areas during the COVID-19 pandemic, based on the normal system functioning.

A systems analysis of the COVID-19 pandemic response in the United Kingdom - Part 1 - The overall context.

The most common reaction to suggesting that we could learn valuable lessons from the way the current pandemic has been/ is being handled, is to discourage the attempt; as it is suggested that it can all be done more accurately and authoritatively after the inevitable Public Inquiry (Slater, 2019). On the other hand, a more constructive approach, is to capture and understand the work that was actually done.This would include normal activities, as well as positive adaptations to challenges and failures that may have occurred.

Safer Systems: People Training or System Tuning?

Safety is usually seen as a problem when it is absent rather than when it is present, where accidents, incidents, and the like represent a lack of safety rather than the presence of safety. To explain this lack of safety, one or more causes must be found. In the management of industrial safety, the human factor has traditionally been seen as a weak element; human error is often offered as the first, and sometimes the only cause of lack of safety and human factors have since the early days offered three principal solutions, namely training, design, and automation.

A novel approach to explore Safety-I and Safety-II perspectives in in situ simulations-the structured what if functional resonance analysis methodology.

Objectives: With ever increasingly complex healthcare settings, technology enhanced simulation (TES) is well positioned to explore all perspectives to enhance patient safety and patient outcomes. Analysis from a Safety-II stance requires identification of human adjustments in daily work that are key to maintaining safety. The aim of this paper is to describe an approach to explore the consequences of human variability from a Safety-II perspective and describe the added value of this to TES.

Measurement of resilience potential - development of a resilience assessment grid for emergency departments.

Background: Resilience engineering has been advocated as an alternative to the management of safety over the last decade in many domains. However, to facilitate metrics for measuring and helping analyze the resilience potential for emergency departments (EDs) remains a significant challenge. The study aims to redesign the Hollnagel's resilience assessment grid (RAG) into a custom-made RAG (ED-RAG) to support resilience management in EDs.

Staff acting resiliently at two hospital wards.

Purpose: The purpose of this paper is to understand how the hospital staff (nurses and physicians) at two hospital wards have coped with everyday work having leaders in conflict or longer periods without one or the other leader and whether the way the staff handled the challenges was resilient.

Design/methodology/approach: Through semi-structured interviews with the staff at the two wards, the authors analysed how the staff were working, if they had cooperation and interdisciplinary cooperation, how they would handle uncertainties and how they coped with the absence of their leaders.

Findings: The staff at both wards were handling the everyday work in a resilient way.

Leadership set-up: wishful thinking or reality?

Purpose: The purpose of the study is to determine whether one leader set-up is better than the others according to interdisciplinary cooperation and leader legitimacy.

Design/methodology/approach: The study is a qualitative study based on semi-structured interviews at three Danish hospitals.

Findings: The study found that the leadership set-up did not have any clear influence on interdisciplinary cooperation, as all wards had a high degree of interdisciplinary cooperation independent of which leadership set-up they had.

Hospital accreditation: staff experiences and perceptions.

Purpose The purpose of this paper is to understand how staff at various levels perceive and understand hospital accreditation generally and in relation to quality improvement (QI) specifically. Design/methodology/approach In a newly accredited Danish hospital, the authors conducted semi-structured interviews to capture broad ranging experiences. Medical doctors, nurses, a quality coordinator and a quality department employee participated.

"Failure-to-Identify" Hunting Incidents: A Resilience Engineering Approach.

Objective The objective was to develop an understanding, using the Functional Resonance Analysis Method (FRAM), of the factors that could cause a deer hunter to misidentify their intended target. Background Hunting is a popular activity in many communities. However, hunters vary considerably based on training, experience, and expertise.

Dual leadership in a hospital practice.

Purpose Despite the practice of dual leadership in many organizations, there is relatively little research on the topic. Dual leadership means two leaders share the leadership task and are held jointly accountable for the results of the unit. To better understand how dual leadership works, this study aims to analyse three different dual leadership pairs at a Danish hospital.

Blood sampling - Two sides to the story.

This study aimed to investigate why there is variability in taking blood. A multi method Pilot study was completed in four National Health Service Scotland hospitals. Human Factors/Ergonomics principles were applied to analyse data from 50 observations, 15 interviews and 12-months of incident data from all Scottish hospitals.

Is compliance with hospital accreditation associated with length of stay and acute readmission? A Danish nationwide population-based study.

Objective: To examine the association between compliance with hospital accreditation and length of stay (LOS) and acute readmission (AR).

Design: A nationwide population-based follow-up study from November 2009 to December 2012.

Setting: Public, non-psychiatric Danish hospitals.

Where the rubber meets the road: using FRAM to align work-as-imagined with work-as-done when implementing clinical guidelines.

Background: Uptake of guidelines in healthcare can be variable. A focus on behaviour change and other strategies to improve compliance, however, has not increased implementation success. The contribution of other factors such as clinical setting and practitioner workflow to guideline utilisation has recently been recognised.

Resilient health care: turning patient safety on its head.

The current approach to patient safety, labelled Safety I, is predicated on a 'find and fix' model. It identifies things going wrong, after the event, and aims to stamp them out, in order to ensure that the number of errors is as low as possible. Healthcare is much more complex than such a linear model suggests.

Accreditation and improvement in process quality of care: a nationwide study.

Objective: To examine whether performance measures improve more in accredited hospitals than in non-accredited hospital.

Design And Setting: A historical follow-up study was performed using process of care data from all public Danish hospitals in order to examine the development over time in performance measures according to participation in accreditation programs.

Participants: All patients admitted for acute stroke, heart failure or ulcer at Danish hospitals.

Compliance with hospital accreditation and patient mortality: a Danish nationwide population-based study.

Objective: To examine the association between compliance with hospital accreditation and 30-day mortality.

Design: A nationwide population-based, follow-up study with data from national, public registries.

Setting: Public, non-psychiatric Danish hospitals.

Human factors/ergonomics as a systems discipline? "The human use of human beings" revisited.

Discussions of the possible future of Human factors/ergonomics (HFE) usually take the past for granted in the sense that the future of HFE is assumed to be more of the same. This paper argues that the nature of work in the early 2010s is so different from the nature of work when HFE was formulated 60-70 years ago that a critical reassessment of the basis for HFE is needed. If HFE should be a systems discipline, it should be a soft systems rather than a hard systems discipline.

[Patient safety in a new perspective].

Effective health care depends on the safe and efficient functioning of a tightly coupled multitude of systems, functions, and specialised services. Both theory and practice have demonstrated how safety management that follows events becomes reduced to uncoordinated and fragmentary fire-fighting. This reactive safety management is inadequate.

Strategies for dealing with resistance to recommendations from accident investigations.

Accident investigation reports usually lead to a set of recommendations for change. These recommendations are, however, sometimes resisted for reasons such as various aspects of ethics and power. When accident investigators are aware of this, they use several strategies to overcome the resistance.

What you find is not always what you fix--how other aspects than causes of accidents decide recommendations for remedial actions.

In accident investigation, the ideal is often to follow the principle "what-you-find-is-what-you-fix", an ideal reflecting that the investigation should be a rational process of first identifying causes, and then implement remedial actions to fix them. Previous research has however identified cognitive and political biases leading away from this ideal. Somewhat surprisingly, however, the same factors that often are highlighted in modern accident models are not perceived in a recursive manner to reflect how they influence the process of accident investigation in itself.