Understanding and responding when things go wrong: key principles for primary care educators

Learning from events with unwanted outcomes is an important part of workplace based education and providing evidence for medical appraisal and revalidation. It has been suggested that adopting a ‘systems approach’ could enhance learning and effective change. We believe the following key principles should be understood by all healthcare staff, especially those with a role in developing and delivering educational content for safety and improvement in primary care. When things go wrong, professional accountability involves accepting there has been a problem, apologising if necessary and committing to learn and change. This is easier in a ‘Just Culture’ where wilful disregard of safe practice is not tolerated but where decisions commensurate with training and experience do not result in blame and punishment. People usually attempt to achieve successful outcomes, but when things go wrong the contribution of hindsight and attribution bias as well as a lack of understanding of conditions and available information (local rationality) can lead to inappropriately blame ‘human error’. System complexity makes reduction into component parts difficult; thus attempting to ‘find-and-fix’ malfunctioning components may not always be a valid approach. Finally, performance variability by staff is often needed to meet demands or cope with resource constraints. We believe understanding these core principles is a necessary precursor to adopting a ‘systems approach’ that can increase learning and reduce the damaging effects on morale when ‘human error’ is blamed. This may result in ‘human error’ becoming the starting point of an investigation and not the endpoint

Evaluation of an Australian Solar Community : Implications for Education and Training

1.1 Background What is renewable energy education and training? A cursory exploration of the International Solar Energy Society website (www.ises.org) reveals numerous references to education and training, referring collectively to concepts of the transfer and exchange of information and good practices, awareness raising and skills development. The purposes of such education and training relate to changing policy, stimulating industry, improving quality control and promoting the wider use of renewable energy sources. The primary objective appears to be to accelerate a transition to a better world for everyone (ISEE), as the greater use of renewable energy is seen as key to climate recovery; world poverty alleviation; advances in energy security, access and equality; improved human and environmental health; and a stabilized society. The Solar Cities project – Habitats of Tomorrow – aims at promoting the greater use of renewable energy within the context of long term planning for sustainable urban development. The focus is on cities or communities as complete systems; each one a unique laboratory allowing for the study of urban sustainability within the context of a low carbon lifestyle. The purpose of this paper is to report on an evaluation of a Solar Community in Australia, focusing specifically on the implications (i) for our understandings and practices in renewable energy education and training and (ii) for sustainability outcomes. 1.2 Methodology The physical context is a residential Ecovillage (a Solar Community) in sub-tropical Queensland, Australia (latitude 28o south). An extensive Architectural and Landscape Code (A&LC) ‘premised on the interconnectedness of all things’ and embracing ‘both local and global concerns’ governs the design and construction of housing in the estate: all houses are constructed off-ground (i.e. on stumps or stilts) and incorporate a hybrid approach to the building envelope (mixed use of thermal mass and light-weight materials). Passive solar design, gas boosted solar water heaters and a minimum 1kWp photovoltaic system (grid connected) are all mandatory, whilst high energy use appliances such as air conditioners and clothes driers are not permitted. Eight families participated in an extended case study that encompassed both quantitative and qualitative approaches to better understand sustainable housing (perceived as a single complex technology) through its phases of design, construction and occupation. 1.3 Results The results revealed that the level of sustainability (i.e. the performance outcomes in terms of a low-carbon lifestyle) was impacted on by numerous ‘players’ in the supply chain, such as architects, engineers and subcontractors, the housing market, the developer, product manufacturers / suppliers / installers and regulators. Three key factors were complicit in the level of success: (i) systems thinking; (ii) informed decision making; and (iii) environmental ethics and business practices. 1.4 Discussion The experiences of these families bring into question our understandings and practices with regard to education and training. Whilst increasing and transferring knowledge and skills is essential, the results appear to indicate that there is a strong need for expanding our education efforts to incorporate foundational skills in complex systems and decision making processes, combined with an understanding of how our individual and collective values and beliefs impact on these systems and processes

Games for a new climate: experiencing the complexity of future risks

This repository item contains a single issue of the Pardee Center Task Force Reports, a publication series that began publishing in 2009 by the Boston University Frederick S. Pardee Center for the Study of the Longer-Range Future.This report is a product of the Pardee Center Task Force on Games for a New Climate, which met at Pardee House at Boston University in March 2012. The 12-member Task Force was convened on behalf of the Pardee Center by Visiting Research Fellow Pablo Suarez in collaboration with the Red Cross/Red Crescent Climate Centre to “explore the potential of participatory, game-based processes for accelerating learning, fostering dialogue, and promoting action through real-world decisions affecting the longer-range future, with an emphasis on humanitarian and development work, particularly involving climate risk management.” Compiled and edited by Janot Mendler de Suarez, Pablo Suarez and Carina Bachofen, the report includes contributions from all of the Task Force members and provides a detailed exploration of the current and potential ways in which games can be used to help a variety of stakeholders – including subsistence farmers, humanitarian workers, scientists, policymakers, and donors – to both understand and experience the difficulty and risks involved related to decision-making in a complex and uncertain future. The dozen Task Force experts who contributed to the report represent academic institutions, humanitarian organization, other non-governmental organizations, and game design firms with backgrounds ranging from climate modeling and anthropology to community-level disaster management and national and global policymaking as well as game design.Red Cross/Red Crescent Climate Centr

"There are too many, but never enough": qualitative case study investigating routine coding of clinical information in depression.

We sought to understand how clinical information relating to the management of depression is routinely coded in different clinical settings and the perspectives of and implications for different stakeholders with a view to understanding how these may be aligned

Towards an ethical framework for the design and development of inclusive home-based smart technology for smart spaces for older adults and people with disabilities

Unique ethical, privacy and safety implications arise for people who are reliant on home-based smart technology due to health conditions or disabilities. As a result we need to carefully reflect on our approaches to ethical issues over the life cycle of smart home technology design and the wider living context for end users and relevant stakeholders. In this position paper we highlight a need for a reflective, inclusive ethical framework for the design of inclusive smart spaces. We present key ethical considerations in the design, development and deployment of smart home-based technology for older adults and people with disabilities. We propose a novel ethical framework for the development of inclusive home-based smart technology which combines these key considerations with existing models of design