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engineering principles to healthcare can be traced to a meeting in 2012 of resilience
engineering and healthcare safety experts led by Hollnagel, Jeffrey Braithwaite and
Robert Wears and has since grown to involve a large and increasingly influential group,
the Resilience Health Care Network (https://resilienthealthcare.net).[13] In the field of
RHC, resilience is defined as the ability of the health care system (a clinic, a ward, a
hospital, a country) 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.[14]
RHC is identified with two complementary approaches to safety – Safety-I and
Safety-II. Neither approach is superior, however one approach might work better than
the other depending on the complexity and predictability of the situation. Safety-I is an
approach that is effective for minimising error in linear systems, where the interaction
between components is well characterised, resulting in well-defined and predictable
outcomes. Linear systems can range from simple to complicated, but the system
outcome can always be predicted with a high degree of certainty provided we know the
system inputs. In linear systems, the boundaries are usually fixed or able to be clearly
defined, which means that local problems can be addressed independently of the larger
system, and solutions can be generalised.
The best examples of linear systems are systems with primarily technological
components, such as the computerised aspects of a digital heath system, or an
anaesthetic machine. For an anaesthetic machine we understand how each of the
electronic and mechanical parts are connected and operate so that the machine can
function, and we can often predict accurately the mean time between failure for these
sub-components. For a linear system, process-oriented controls such as standardisation
of manufacture and operation provide effective safety measures, and barriers to error
propagation across such a system can be applied effectively.
Once we add a sociological component, such as normal human behaviour, into the
system, it becomes more complex, and Safety-I solutions become less effective. In
contrast, Safety-II is an approach that is suited to a complex system. Rather than
focusing on failures, Safety-II thinking tries to understand how human performance
nearly always goes well and leverages that information to improve the number of
things that go right. In a complex system, boundaries can be porous, and there is
significant interaction between local context and the larger system. Rather than adding
system controls or barriers, which is difficult to do when boundaries are not well-
defined, a Safety-II approach will try to simplify the system and rely on the adaptability
of the humans in the system to adjust their performance in response to changing system
demands.
To apply RHC principles in the workplace to improve the number of things that go
right, we need to understand ‘Work-as-Done’, or how clinicians make continuous small
and large adjustments during their daily work, to satisfy the changing needs of patient
care. In complex systems, ‘Work-as-Done’ is usually different to Work-as-Imagined’
by those who administer healthcare and who develop the rules and procedures that
clinicians must follow. This can result in different assumptions across hospitals of how
tasks are accomplished, and can make implementation of new processes and procedures
difficult and, sometimes, unsafe for patients. A digital health system that is designed
without in-depth knowledge of how everyday work is accomplished may not be usable
by clinicians, and result in clinician frustration and workarounds.
In terms of implementation science, RHC can be considered a determinant
framework[15] that helps us to design and implement successful interventions through
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Buch Applied Interdisciplinary Theory in Health Informatics - Knowledge Base for Practitioners"
Applied Interdisciplinary Theory in Health Informatics
Knowledge Base for Practitioners
- Titel
- Applied Interdisciplinary Theory in Health Informatics
- Untertitel
- Knowledge Base for Practitioners
- Autoren
- Philip Scott
- Nicolette de Keizer
- Andrew Georgiou
- Verlag
- IOS Press BV
- Ort
- Amsterdam
- Datum
- 2019
- Sprache
- englisch
- Lizenz
- CC BY-NC 4.0
- ISBN
- 978-1-61499-991-1
- Abmessungen
- 16.0 x 24.0 cm
- Seiten
- 242
- Kategorie
- Informatik