Understanding safety in healthcare: the system evolution, erosion and enhancement model

The paper summarises previous theories of accident causation, human error, foresight, resilience and system migration. Five lessons from these theories are used as the foundation for a new model which describes how patient safety emerges in complex systems like healthcare: the System Evolution Erosion and Enhancement model. It is concluded that to improve patient safety, healthcare organisations need to understand how system evolution both enhances and erodes patient safety

Flexible and adaptable hospitals – Australian case studies

In 2009, a literature review uncovered different international approaches to achieving flexible and adaptable health facilities and concluded by recommending further research focussing on Australian hospitals to identify key site issues, design features, and major upgrades that have influenced longer term responses to changing modes of service delivery and other demands in local settings. Responding to these recommendations, this second stage research was conducted by reviewing further relevant literature and project documentation for five case studies, visiting and documenting key adaptability features of each case study facility and consulting with health facility personnel where available. Findings include that longer-term flexibility is assisted by: generous site area, lower rise hospital buildings along a horizontal circulation spine (‗hospital street‘), surplus building services capacity facilitating easy expansion/alteration, and a consistent workable planning grid supporting a range of standardised room sizes. Future investigation should consider the impact of high land values on site utilisation especially in terms of future proofing multi-storey buildings, and how to assist health clients decide when ‗enough‘ flexibility has been provided

Discovery, development, and commercialization of gold catalysts for acetylene hydrochlorination

Vinyl chloride monomer (VCM) is a major chemical intermediate for the manufacture of polyvinyl chloride (PVC), which is the third most important polymer in use today. Hydrochlorination of acetylene is a major route for the production of vinyl chloride, since production of the monomer is based in regions of the world where coal is abundant. Until now, mercuric chloride supported on carbon is used as the catalyst in the commercial process, and this exhibits severe problems associated with catalyst lifetime and mercury loss. It has been known for over 30 years that gold is a superior catalyst, but it is only now that it is being commercialized. In this Perspective we discuss the use and disadvantages of the mercury catalyst and the advent of the gold catalysts for this important reaction. The nature of the active site and the possible reaction mechanism are discussed. Recent advances in the design and preparation of active gold catalysts containing ultralow levels of gold are described. In the final part, a view to the future of this chemistry will be discussed as well as the possible avenues for the commercial potential of gold catalysis

Overview of Australian Healthcare Sector, Models of Care, Case Studies (presentation)

International Project Finance Association (IPFA): Trends and Pressures in Australasian Healthcare Projects, Sydney, 19 Augus

Assessing & developing design standards and guidelines for the modern operating theatre

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Safety analysis over time: seven major changes to adverse event investigation

© 2017 The Author(s).BackgroundEvery safety-critical industry devotes considerable time and resource to investigating and analysing accidents, incidents and near misses. The systematic analysis of incidents has greatly expanded our understanding of both the causes and prevention of harm. These methods have been widely employed in healthcare over the last 20 years but are now subject to critique and reassessment. In this paper, we reconsider the purpose and value of incident analysis and methods appropriate to the healthcare of today.Main textThe primary need for a revised vision of incident analysis is that healthcare itself is changing dramatically. People are living longer, often with multiple co-morbidities which are managed over very long timescales. Our vision of safety analysis needs to expand concomitantly to embrace much longer timescales. Rather than think only in terms of the prevention of specific incidents, we need to consider the balance of benefit, harm and risks over long time periods encompassing the social and psychological impact of healthcare as well as physical effects.We argued for major changes in our approach to the analysis of safety events: assume that patients and families will be partners in investigation and where possible engage them fully from the beginning, examine much longer time periods and assess contributory factors at different time points in the patient journey, be more proportionate and strategic in analysing safety issues, seek to understand success and recovery as well as failure, consider the workability of clinical processes as well as deviations from them and develop a much more structured and wide-ranging approach to recommendations.ConclusionsPrevious methods of incident analysis were simply adopted and disseminated with little research into the concepts, methods, reliability and outcomes of such analyses. There is a need for significant research and investment in the development of new methods. These changes are profound and will require major adjustments in both practical and cultural terms and research to explore and evaluate the most effective approaches

Australian e-guidelines for health facility design

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