What lies beneath? The role of informal and hidden networks in the management of crises

Crisis management research traditionally focuses on the role of formal communication networks in the escalation and management of organisational crises. Here, we consider instead informal and unobservable networks. The paper explores how hidden informal exchanges can impact upon organisational decision-making and performance, particularly around inter-agency working, as knowledge distributed across organisations and shared between organisations is often shared through informal means and not captured effectively through the formal decision-making processes. Early warnings and weak signals about potential risks and crises are therefore often missed. We consider the implications of these dynamics in terms of crisis avoidance and crisis management

Large-scale Complex IT Systems

This paper explores the issues around the construction of large-scale complex systems which are built as 'systems of systems' and suggests that there are fundamental reasons, derived from the inherent complexity in these systems, why our current software engineering methods and techniques cannot be scaled up to cope with the engineering challenges of constructing such systems. It then goes on to propose a research and education agenda for software engineering that identifies the major challenges and issues in the development of large-scale complex, software-intensive systems. Central to this is the notion that we cannot separate software from the socio-technical environment in which it is used.Comment: 12 pages, 2 figure

A Systems Thinking Approach to Redesigning the Patient Experience to Reduce 30 Day Hospital Readmission

INTRODUCTION The cost of medical care is spiraling out of control, and one of the many reasons is lack of preventative care, poor communication to the patient and primary caregiver(s) both in an inpatient and outpatient setting. There are potentially many reasons for this cost escalation, one of the drivers of this cost is 30 day readmission after a hospitalization and this is what was examined in this analysis. The purpose of this paper in particular is to share what has been learned using a systems thinking approach to hospital readmissions and the patient experience. It is critical to understand the problems that occurred in the past. In addition, we will explain the methodology utilized and bring awareness to the iterative process. We will also demonstrate a suggested redesigned model

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

Technologie en innovatie in Vlaanderen: Prioriteiten.

Vlaanderen;

The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia

An interprofessional, intercultural, immersive short-term study abroad program: public health and service systems in rome

The purpose of this paper is to describe a short-term study abroad program that exposes engineering and nursing undergraduate students from the United States and Italy to an intercultural and interprofessional immersion experience. Faculty from Purdue University and Sapienza Università di Roma collaborated to design a technical program that demonstrates the complementary nature of engineering and public health in the service sector, with Rome as an integral component of the program. Specifically, the intersection of topics including systems, reliability, process flow, maintenance management, and public health are covered through online lectures, in-class activities and case study discussions, field experiences, and assessments. Herein, administrative issues such as student recruitment, selection, and preparation are elucidated. Additionally, the pedagogical approach used to ensure constructive alignment among the program goals, the intended learning outcomes, and the teaching and learning activities is described. Finally, examples of learning outcomes resulting from this alignment are provided

Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness

<b>Background</b> In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding - and sometimes preventing - disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment.<p></p> <b>Discussion</b> As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization.<p></p> <b>Summary</b> Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts

An analytic framework to assess organizational resilience

Background: Resilience Engineering is a paradigm for safety management that focuses on coping with complexity to achieve success, even considering several conflicting goals. Modern socio-technical systems have to be resilient to comply with the variability of everyday activities, the tight-coupled and underspecified nature of work and the nonlinear interactions among agents. At organizational level, resilience can be described as a combination of four cornerstones: monitoring, responding, learning and anticipating. Methods: Starting from these four categories, this paper aims at defining a semi-quantitative analytic framework to measure organizational resilience in complex socio-technical systems, combining the Resilience Analysis Grid (RAG) and the Analytic Hierarchy Process (AHP). Results: This paper presents an approach for defining resilience abilities of an organization, creating a structured domain-dependent framework to define a resilience profile at different levels of abstraction, to identify weaknesses and strengths of the system and thus potential actions to increase system’s adaptive capacity. An illustrative example in an anaesthesia department clarifies the outcomes of the approach. Conclusions: The outcome of the RAG, i.e. a weighted set of probing questions, can be used in different domains, as a support tool in a wider Safety-II oriented managerial action to bring safety management into the core business of the organization