Page - 140 - in Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners

Figure 3. Resolving calls – counsellor. 2.2. Designing information systems to cope with unexpected events How health informatics can enable systems to cope with the unexpected will be illustrated through a case study of a thunderstorm asthma event in Melbourne, Australia.[26] Over two days in November 2016, nearly 10,000 people presented at hospital Emergency Departments with breathing difficulties, and nine people died. The efficiency and effectiveness of locally embedded health information networks enabled emergency services to manage the unanticipated increase in ambulance calls and hospital presentations, however the crisis revealed deficiencies in command and control level information systems. A useful tool for proactive evaluation of resilience in response to unexpected events is the Resilience Assessment Grid (RAG).[27] The RAG was derived by considering four essential capabilities of resilience (Figure 4): knowing what to do in response to unexpected occurrences and being capable of doing it (actual), knowing how to identify early that developing events might prove problematic (critical), knowing what to expect as events develop (potential), and learning from what has happened in the past (factual). The ability to respond includes taking unpredictability into account and adjusting responses to enable local experts to improvise. The ability to monitor includes tracking how things are being done well and understanding Work-as-Done. The ability to anticipate includes policy makers balancing prescriptive controls with local level discretion, improvisation and judgement. The ability to learn should be based on frequency and severity of what goes right. The RAG can be proactively applied by evaluating an organisation in terms of the four capabilities. This evaluation is usually completed as a series of probing questions that can be answered via a combination of interviews, focus groups, ethnography and audit or document review. R.Clay-WilliamsandJ.Braithwaite /ResilientHealthCare140