As Demandas de Proteção da Sociedade e os Direitos Individuais na Legislação de Saúde — Exemplos da Noruega

Este artigo apresenta a legislação atual relacionada ao tratamento compulsório de pacientes com desordens psiquiátricas e as medidas contra ameças de transmissão de doenças para a saúde na Noruega. O papel do profissional médico é destacado e analisado considerando procedimentos previstos na legislação. O trabalho mostra as necessidades de procedimentos que são usadas para proteger os direitos individuais dos pacientes e o julgamento profissional em cada situação, dirigido pelo quadro legislativo

As Demandas de Proteção da Sociedade e os Direitos Individuais na Legislação de Saúde — Exemplos da Noruega

Este artigo apresenta a legislação atual relacionada ao tratamento compulsório de pacientes com desordens psiquiátricas e as medidas contra ameaças de transmissão de doenças para a saúde na Noruega. O papel do profissional médico é destacado e analisado considerando procedimentos previstos na legislação. O trabalho mostra as necessidades de procedimentos que são usadas para proteger os direitos individuais dos pacientes e o julgamento profissional em cada situação, dirigido pelo quadro legislativo

An Attribute Perspective on Regulatory Regimes in Risk Governance

Increasing interest from stakeholders has brought new focus on risk governance and risk regulation, such as the regulator’s execution of duty and tangible results on safety and environmental protection in oil and gas industry. One recent example, from 2019, is the Office of the Auditor General Norway’s (OAG) investigation of the Petroleum Safety Authority’s (PSA) follow-up on health, safety and the environment in the petroleum industry, where the regulatory regime in Norway resting on functional requirements was questioned. Simplistically speaking, there are two current traditions or main schools in regulatory regimes: use of functional requirements associated with co-regulation and use of normative requirements associated with prescriptive regulation. In this paper, we introduce a generic model from an attribute perspective on contrasting, gauging or evaluating the two different regulatory regimes. Furthermore, this approach may explain the controversy regarding the favouring of functional or prescriptive regulatory regimes by the different players in the industry. Our case is based on regulations relating to offshore oil and gas operations, in particular focusing on the Norwegian sector. We use the OAG’s investigation of the PSA and the public reaction as our material because this material is proposed to provide a thorough and valid description of how the effects of the Norwegian regulatory regime are perceived from the outside. We believe that the generic concept presented here is applicable when performing investigations in other industries involved in hazardous activities.publishedVersio

A tool to assess learning processes based on the cooperation principle

A strategy for cooperation in emergency management has been developed and politically agreed upon by the Rogaland County Council, Norway. The region comprised by the strategy consists of many different actors within societal safety and emergency management. The strategy aims at strengthening the existing cooperation, establishing professional centres and further developing competencies in their emergency response efforts within the region. The region has more than twenty road tunnels either in the planning phase, under construction or in operation. The emergency services have established a new organisation of their cooperation to ensure coordination, learning and supervision. This relates both to exercises and real event operations. An important tool in this respect is a recently developed handbook for cooperative exercises. The book is used in planning, execution and follow-up of all cooperation exercises. In this paper we present our newly developed evaluation model for following up the cooperation exercise guidelines, with special attention to events in road tunnels. We employ a learning model that extends the notion of learning from observed changes to also include confirmation and comprehension of cooperation activities.acceptedVersio

Uma comparação das regulações de trabalho relacionadas à proteção da saúde no setor petroleiro no Brasil e na Noruega

The purpose of this article is to compare the regulations on work related health issues in the offshore petroleum sector in Brazil and Norway. The regulation of reporting and handling of work related illness has been used as a case for the study. We aim to show that even though the legislation both in Brazil and Norway relies upon similar legislative traditions, emphasising statute law, with written norms given by national authorities, there are considerable differences in how the regulation is developed and how the this kind of norms are formulated in the two countries. The differences will be interpreted in view of the governance cultures in the petroleum sector in the two countries. What can be learnt from this comparison may be of general interest when working with development of legislation and regulations.Este trabalho apresenta um estudo comparativo das principais características dos modelos de regulação adotados em assuntos relacionados à saúde do trabalhador no setor petroleiro no Brasil e na Noruega. As legislações de ambos os países estão inseridas na tradição da lei escrita, mas cada nação tem uma abordagem particular de sua regulação. O Brasil conta com uma típica postura regulatória, enquanto a Noruega apresenta traços do direito consuetudinário, com modelos legais baseados na presunção de que as partes envolvidas são capazes de agregar boas e seguras práticas profissionais. Percebe-se que ambas as abordagens regulatórias relacionam-se com o panorama social de cada nação. Porém, como o tempo e a cultura se modificam, os dois países talvez tenham algo a aprender um com outro

Conceptualizing the bending and breaking of rules in the heavy goods transport sector

Heavy goods vehicles (HGVs) are a critical factor in road traffic safety for “Vision Zero-events”, defined as road accidents with fatalities and serious injuries. The bending and breaking of safety-related rules in the HGV-sector, such as not following rest and work hour regulations, not securing cargo sufficiently, or not following the regulations concerning cabotage, in the commercial goods transport sector is a cause for concern and has in a very limited degree been studied as a system problem. This paper suggests that deregulation and international competition in the transport sector are bringing about a working climate where even serious safety-minded actors in the HGV business find themselves needing to cut corners to stay in business. The current situation in the Norwegian HGV sector is such that the organization of the business, the market development and the regulatory regimes are in effect transferring the responsibility for traffic safety vertically downwards to the actors at the lowest levels of the transport system. These actors are the truck drivers, who often bend and break rules to perform their work on time. This paper presents a scoping study designed to address the concept of rule bending in the HGV transport sector, using a combination of peer reviewed literature and a heterogeneous sample of grey literature from the transport sector. The scoping study shows how the scientific literature discusses violations and transgressions as both intentional and nonintentional acts but does not adequately describe how certain types of behaviour differ from overt violations and transgressions. The actions are simply considered violations that are devoid of meaning and both systemic and cultural context. We suggest a conceptualization of rule bending and rule breaking as “Adaptive Non-conforming Behaviour (ANB)” that builds on the context found in the grey literature. Further, the conceptualization provides a framework for the recognition of ANB, dimensions for further study and an outlined research design. We believe there is a need to increase system knowledge because safety analysis lacks in-depth insight into how the system affect the working practices in the HGV sector. The justification of the ANB approach is that it can be incorporated into safety and risk assessments of the transport sector, to provide a framework for context-sensitive studies that are non-normative, less concerned with violations as rule breaking, and more concerned with rule bending as a system wide problem.publishedVersio

Next-of-kin involvement in improving hospital cancer care quality and safety – a qualitative cross-case study as basis for theory development

Background Next-of-kin are an extension of healthcare professionals in all stages of cancer care. They offer care activities such as interpretations of symptoms, and reporting of negative or adverse effects of treatment, without any professional knowledge or skills. Their participation is often expected from healthcare professionals, managers, or the patient. However, there is limited knowledge of next-of-kin’s role in and contribution to quality and safety improvement in hospital cancer care. The aim of this study was to explore how managers and healthcare professionals understand the role of next-of-kin in cancer care, and what methods they use for next-of-kin involvement. Methods The study design was a comparative multiple embedded case study of cancer departments in two Norwegian university hospitals. Data collection methods consist of qualitative interviews with managers (13) and healthcare professionals (19) collected in 2016, and document analysis of policy documents and regulation. The interviews were analyzed according to a directed content analysis approach guided by the theoretical framework ‘Organizing for Quality’. Results Both hospitals have a strategy to involve next-of-kin in treatment and care but have no formal way of doing so. Managers and healthcare professionals in the two hospitals illuminated nine areas where next-of-kin are important stakeholders in improving quality and safety. These nine areas (e.g. nutrition, observations, transitions, pain treatment, information, palliative and terminal care) are common across the two hospitals. Key challenges in the next-of-kin involvement pertain to insufficient physical working conditions and room facilities, and lack of continuity of experienced nurses and consultants. Conclusion Hospital employees and managers regard next-of-kin as a safety net or a buffer that cannot be replaced by other stakeholders. This study shows a close collaboration between patient, next-of-kin and healthcare professionals in cancer care, but more effort should be invested in more systematic approaches for next-of-kin involvement in quality and safety improvement such as a guide for managers and healthcare professionals on methods and areas of involvement.publishedVersio

Coping with different system logics of standardization in regulatory regimes. Norwegian offshore experience

This paper addresses the role of standardization in risk governance and explores challenges when unifying different system logics and standardizations in the regulator-regulated relationships in different industrial, political, and cultural contexts. High-risk regulatory regimes have been at the forefront in developing regulations management, founded on function-, purpose- and goal-based regulations. A key perspective in our analysis is to examine the importance of “standardization” as an institutional approach and regulatory mechanism. The new era of free trade and globalization causes constant reorganization in industries that are trying to seize opportunities and increase competitiveness. The high-risk industries today, therefore, are undergoing major changes, due to downsizing and mergers, which inevitably affect and challenge their safety levels. The paper bases its discussion on several empirical studies of industrial dynamics and innovation in petroleum, mainly from the empirical context of the North Sea petroleum region.publishedVersio

Fødselsomsorgen kan bli bedre

Til tross for en god fødselsomsorg i Norge skjer det uønskede hendelser med alvorlig utfall for mor og/eller barn. I media kan man jevnlig lese om alvorlige hendelser i forbindelse med fødsel, der tema ofte er dødsfall eller skade som følge av manglende eller feil helsehjelp. Disse historiene gjør inntrykk. Det er ikke bare den berørte familien som blir hardt rammet, det er også de involverte fødselshjelperne. Den psykiske belastningen kan for noen være så stor at de ikke ønsker å arbeide videre i fødselsomsorgen (1). Omkring halvdelen av slike uønskede hendelser kunne vært unngått hvis fødselen hadde blitt håndtert annerledes (2–4). Hva er det som kan gå galt under fødsel, og hvorfor ser det ut til at samme type hendelser skjer igjen og igjen

Emergency preparedness for tunnel fires – A systems-oriented approach

Efficient emergency response is key to preventing major losses in tunnel fires. Our general concern in this paper is the degree to which tunnel systems are prepared and the means by which we can be prepared for a major fire in a single-tube road tunnel. Conformance to prescriptive regulations dominates existing practice in the area of emergency preparedness. Risk-based approaches exist but have little influence on emergency preparedness designs for tunnel systems. A successful emergency response to tunnel fires is dependent on many actors collaborating under serious time constraints. Safety becomes a matter of controlling critical processes necessary to keep the system in a safe state. Efficient decision-making in situations of major uncertainty is vital, to achieve safety goals. This essentially means that efficient emergency preparedness for road tunnels is a matter that needs attention in the early design phases and continuous improvements during the operational phase. To achieve high-performance emergency preparedness against tunnel fires, there is a need for radical changes to the design and operation of tunnels. In this paper, it is claimed that a system-theoretic approach is appropriate to deal with the tunnel system’s complexity and to drive the design of appropriate control structures for critical processes, from the design phase to the actual emergency. It is shown how system theoretic approaches will change the safety management practices for tunnels and how this will increase consistency between potential fire scenarios and associated control actions.publishedVersio