Morbidity in anaesthesia: Today and tomorrow

SAFETY, CULTURE AND RISK. THE ORGANISATIONAL CAUSES OF DISASTERS Andrew Hopkins Sydney: CCH Australia 2005, 172 pp, AUD65.00 ISBN: 1 921 022 256Andrew Hopkins is one of Australia's foremost thinkers on workplace safety. LHe has been influential in drawing attention to failures by organisations, as distinct from failures by individuals, as the causes of major disasters in Australian mines and chemical plants. Therefore a new book from him is read with anticipation of providing further help in understanding the complexity of these events: he does not disappoint.Safety, Culture and Risk is best approached as a collection of five essays rather than as chapters in a book. The foreword by James Reason, an internationally distinguished authority on accidents, sets the scene. Reason notes that technical or mechanical failures as causes of accidents have become uncommon, whereas human performance problems have come into greater prominence. These are sometimes described as 'human error', but many investigations have shown that the workers immediately involved are not so much the instigators of bad events as the inheritors of an accident waiting to happen. Hopkins pursues this theme by looking for the 'causes of the causes' in the two main essays.The major essay examines the Glenbrook (NSW) train crash in which seven people died in 1999; a tragedy eerily foreshadowing the similarly fatal Waterfall train crash of 2003. Whilst the immediate cause of the Glenbrook crash was due to a train driver passing a failed red signal with the blessing of the signal operator, Hopkins doggedly identifies the series of failures in the rail organisation which led to this behaviour. These include: a preoccupation with endless rules for train drivers to follow and associated disempowerment to make sensible decisions; the disaggregation of the railways into separate companies, weakening any sense of cooperation between employees from different companies in achieving safety; a premium placed on 'on time running' leading to a conflict with safety considerations; and a complacency about safety risks. There is an excellent flowchart which shows the complexity of interaction of these various forces leading to the accident.A shorter essay examines the problems which arose from the 'deseal/reseal' program for repairing the fuel tanks of Fl 11 fighters in the RAAF. The solvents used in this program caused extensive neuro-psychological harm to many ground-crew and resulted in a major Board of Inquiry of which Hopkins was a member. The proximate causes of the injuries could be attributed to failure to use personal protective equipment; however the equipment sometimes dissolved in the solvents and was very difficult to wear in the space and heat inside the fuel tanks. Hopkins identifies several factors operating in the RAAF which contributed to the injuries. These included a lack of attention by medical personnel to complaints from the workers over many years; the priority placed on operational flying over the supporting logistics; the lack of authority for those involved with health and safety of ground crew compared to aircrew; and inadequate systems for reporting incidents in ground crew compared to aircrew. …

Safety, Culture and Risk. the Organisational Causes of Disasters

Work is a major issue in the discussions on the Covid-19 pandemic, whose consequences impair the capacities of workers at all organizational levels and impose unexpected challenges on managers. Nevertheless, the scientific literature still lacks an overview of how researchers have been covering the issue. This article presents a systematic review to investigate the impact of Covid-19 on work and workers of all occupations, reveal research gaps, and help managers to adapt to organizations amid the pandemic. This review is based on a sample of 258 papers from Web of Science and Scopus databases. Quantitative and qualitative analysis indicated a vast majority of studies focused on frontline healthcare workers and a lack of empirical investigation on managers' work. We show how literature has been addressing different aspects of work (e.g., workers' health, working conditions, procedures, protection equipment, remote working, etc.) in the various economic sectors. We discuss the results in light of ergonomics and psychodynamics of work, two disciplines that conceive work and organization as intimately connected, and that can assist managers in meeting the difficulties brought by the pandemic. We highlight that considering the construction of health, interindividual variability, subjective relation to work, supportive workplace environment, and organizational and individual capabilities can play a key role in successfully adapting and transforming organizations in the current scenario.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/hfm.20889

A systematic review on the impacts of Covid-19 on work: Contributions and a path forward from the perspectives of ergonomics and psychodynamics of work.

Les organisations hospitalieres sont confrontees a des evolutions constantes : evolution technologique, evolution societale des attentes, place de l’usager de plus en plus affirmee, mutations organisationnelles preconisees par les tutelles et un eventail de reformes qui se telescopent parfois. Les etablissements de sante sont au coeur des reformes du systeme de sante et doivent continuellement s’adapter aux changements. La mise en oeuvre des nouvelles politiques de sante souleve la question de l’adaptation des organisations hospitalieres : adaptation liee a la mutation de l’environnement, a la multiplication des interactions entre les acteurs, a la prise en compte des reseaux de soins, des poles d’activites et des processus transverses. Le domaine de la qualite a l’hopital est egalement devenu une exigence legale et reglementaire. Depuis la loi hospitaliere du 31 juillet 1991 et des ordonnances d’avril 1996 introduisant l’obligation de la mise en oeuvre d’une procedure d’evaluation externe, de nombreuses evolutions reglementaires concernant les demarches de certification des etablissements de sante se greffent a contexte organisationnel deja contraint. L’integration de la demarche qualite a l’hopital est renforcee. Des 2020, les etablissements constituant les Groupements Hospitaliers de Territoires seront soumis a une procedure de certification commune. L’articulation de l’offre de soins autour de projets medicaux partages amplifie les synergies strategiques et operationnelles des etablissements de sante autour d’une dimension transversale et conjointe de la demarche qualite et gestion des risques. Les evolutions reglementaires qui ont marquees les organisations hospitalieres ont ainsi participe a l’implementation d'outils de gestion a visee rationalisante et la prise en compte de la qualite comme outil de gestion s’est peu a peu developpee. Car si la qualite a d’abord ete envisagee comme une reduction technique de non-conformites, l’integration du facteur humain a largement contribue a penser la qualite comme un outil de gestion. De fait, les strategies d’integration de la demarche qualite par les outils de gestion dans les organisations hospitalieres peuvent etre porteuses. En effet, les outils de gestion sont des elements structurants de l’organisation. Ils participent a sa construction en influant sur les roles sociaux des acteurs. Nous pensons que l’utilisation des outils de gestion de la qualite participe au deploiement de la demarche qualite. Ainsi, nous avons choisi de determiner les leviers d’appropriation de la demarche qualite en nous appuyant sur l’etude d’un outil de gestion de la qualite : la fiche de declaration des evenements indesirables. Etudier un outil de gestion de la qualite dans un contexte organisationnel implique l’etude de l’outil lui-meme, mais egalement les determinants contextuels propres a l’organisation dans laquelle il vit. L’ancrage de l’outil n’occulte en aucune facon son histoire, l’environnement dans lequel il evolue, les intentions des concepteurs ou encore le contexte social et culturel. Ainsi, une prise en compte contextualisee de l’outil peut etre un moyen de mesurer le niveau d’integration de la demarche qualite d’une organisation hospitaliere. En effet, les principes d’integration de la demarche qualite ne sont pas portes par une methode type qui serait reproduite a l’identique dans n’importe quelle organisation hospitaliere, ils sont integratifs des facteurs de contingence specifiques a l’organisation et du niveau de maturite organisationnel dans le domaine de la qualite et de la gestion des risques. La premiere partie de ce travail delimite les concepts de qualite a l’hopital et d’outils de gestion. La seconde partie fondee sur une approche empirique des outils de gestion de la qualite repose sur l’idee qu’il est possible de proposer un modele de mesure des facteurs d’integration de la qualite a l’hopital a destination des managers hospitaliers

https://tel.archives-ouvertes.fr/tel-01561792/document

Vers un modèle intégrateur des démarches qualité à l'hôpital : l'apport des outils de gestion

Developing a method to improve safety management systems based on accident investigations: The SAfety FRactal ANalysis

Ce document propose une synthese des connaissances sur les facteurs humains et organisationnels de la securite industrielle. Il s'attache a integrer les facteurs humains et organisationnels dans les politiques et pratiques de securite industrielle necessite de pouvoir s'appuyer sur des connaissances nouvelles ouvrant aux sciences humaines et sociales (ergonomie, psychologie, sociologie, etc.), tout en faisant le lien avec des problematiques operationnelles concretes.

https://hal.archives-ouvertes.fr/hal-00776052/document

Les facteurs humains et organisationnels de la sécurité industrielle: un état de l'art.

Over time, in order to manage industrial risks, companies have developed measures aiming continually to improve the reliability of facilities and the implementation of safety manage- ment systems. Whilst there is no question that significant progress has been made, safety results seem to have reached a plateau and further progress requires human and organizational factors to be taken into account. However, achieving such changes will not happen automatically: the industrial approach still tends to focus on the behaviour of operators ,on human error and on compliance with procedures, neglecting the positive contribution of humans to safety and limiting the understanding of deeper yet essential causes; companies often have a pronounced technical culture and very rarely possess in-house expertise in the area of human and organizational factors of safety; there have been few reference documents published with the aim of facilitating the transfer of scientifically acquired knowledge to those involved in safety (industrial companies, trade unions, regulators, etc.). In short, including human and organizational factors in industrial safety policies and practices means drawing on new knowledge from the human and social sciences (ergonomics, psychology, sociology and others), and finding ways to link this with concrete operational issues. The aim of this document is to respond to this need. It is the result of the work of a number of people over several phases: As part of its call for proposals concerning "technical, human and organizational vulnerabilities and the quest for safety", the Fondation pour une Culture de Securite Industrielle (FonCSI, Foundation for an Industrial Safety Culture) selected and funded a team of recognized researchers with extensive experience in high-risk industries (nuclear, petrochemical and transport). The researchers produced a document based on their scientific expertise, according to a structure tested in training sessions run by the Institut pour une Culture de Securite Industrielle (ICSI, Institute for an Industrial Safety Culture) about human and organizational factors and aimed at site managers, members of management teams and trade unions. This document formed the basis for numerous discussions with operational stake holders from a variety of backgrounds (industrial leaders, union representatives, specialists from research or expert institutes, etc.) brought together as part of the ICSI discussion group on human and organizational factors of safety. As a result, this original approach makes it possible to propose a frame of reference that is common to all industrial safety stakeholders who wish to reinforce their preventive measures by giving better consideration to the role of the individual and the organization.

https://hal.archives-ouvertes.fr/hal-00675538/document

Human and organizational factors of safety : state of the art.

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Les facteurs humains et organisationnels de la sécurité industrielle: un état de l'art.

Human and organizational factors of safety : state of the art.