人的多重防護を巡って : Resilience Engineering の観点から

Process Improvement and Patient Safety

What is it that makes a profession a profession and assures its members special status? What do professionals need to be able to claim their turf and establish priority over others who interact wit...

The gold standard: the challenge of evidence-based medicine and standardization in health care

approved: _____________________________________________________ Chinweike I. Eseonu In the face of a disruptive event or prolonged period of stress, resilient performance is characterized by preventative measures, effective response, and the integration of lessons learned. In healthcare, resilience significantly affects patient safety. However, current guidelines for healthcare performance assessment, such as the Triple Aim, do not consider physician satisfaction and preventative measures against burnout. Consequently, burnout significantly affects healthcare providers' cognitive and emotional capacity. In addition, process improvement projects in healthcare often have a negative impact on resilience by over-standardizing processes. This research utilizes Resilience Engineering approaches to evaluate organizational resilience in one emergency department and two primary care case study examples. A qualitative method is applied to gain understanding of characteristics of resilient employees and learning behaviors that impact overall resilience. Frequency of single and double loop learning behaviors are observed and a resilient healthcare system is defined as one in which all organizational actors exhibit double loop learning behaviors. Results give insights into the relationship between individual and organizational resilience by adapting resilient systems attributes and capabilities to healthcare settings. A typology based on the dimensions of organizational and individual resilience is presented, providing a mode for healthcare managers and academic professionals to characterize resilience in specific organizations. ©Copyright by Lucia Darrow 15 May 2017 All Rights Reserved Exploring the Factors that Drive Organizational Resilience: Lessons from Healthcare by Lucia Darrow

/pdf/exploring-the-factors-that-drive-organizational-resilience-stky330prw.pdf

Exploring the factors that drive organizational resilience : Lessons from healthcare

Resilience is the intrinsic ability of a system to adjust its functioning prior to, during, or following changes and disturbances so that it can sustain required operations, even after a major mishap or in the presence of continuous stress. As an emergent property of systems that is not tied to tallies of adverse events or estimates of their probability, resilience provides the means for organizations to target resource investments by integrating safety and productivity concerns. Resilience engineering (RE) can enable an organization to cope with and recover from unexpected developments, such as maintaining the ability to adapt when demands go beyond an organization’s customary operating boundary. Understanding resilience makes the difference between organizations that inadvertently create complexity and miss signals that risks are increasing, and those that can manage high-hazard processes well. We discuss two examples of resilience: the response of an emergency department staff to surges in patient volume and design improvements to the infusion device control/display interface.

/pdf/minding-the-gaps-creating-resilience-in-health-care-eibicl3ef7.pdf

Minding the Gaps: Creating Resilience in Health Care

Pressures for improved safety and performance in healthcare often are addressed by the imposition of tighter control over processes directed at producing "perfect performance of work." A series of near-miss incidents related to a routine hospital procedure demonstrates how these efforts can yield unintended and unappreciated consequences, undermining system resilience and safety despite the best of intentions. Attention to conflicts between goals and tasks across the organization and the role of workers in creating resilience are overlooked as contributors to system safety.

Ironies of improvement: organizational factors undermining resilient performance in healthcare

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Ironies of improvement: organizational factors undermining resilient performance in healthcare