A Case for TIC: A Complex Adaptive Systems Enquiry for Trauma Informed Care

Trauma Informed Care (TIC) is an approach to human services based on the understanding that most people in contact with services are more likely to have experienced some level of trauma, adversity and loss and this understanding needs to be held by those involved so that it is may permeate service relationships and delivery. This article reviews TIC literature and introduces a case example outlining the successes and challenges of TIC implementation in practice, i.e. staff awareness, knowledge and skills, communication and quality of human interaction, wellbeing and resilience, organisational structures and artefact, measurement and monitoring for success. Insights from complexity and interpersonal neurobiology are interpreted in the context of facilitating TIC implementation, i.e. parallel safe-to-fail interventions, managing constraints and boundary conditions, monitoring change through trusted sensor networks, maintaining awareness development practices

A study to assess the influence of interprofessional point of care simulation training on safety culture in the operating theatre environment of a university teaching hospital.

Interprofessional point of care or in situ simulation is used as a training tool in our operating theatre directorate with the aim of improving crisis behaviours. This study aimed to assess the impact of interprofessional point of care simulation on the safety culture of operating theatres. A validated Safety Attitude Questionnaire was administered to staff members before each simulation scenario and then re-administered to the same staff members after 6-12 months. Pre- and post-training Safety Attitude Questionnaire-Operating Room (SAQ-OR) scores were compared using paired sample t-tests. Analysis revealed a statistically significant perceived improvement in both safety (p < 0.001) and teamwork (p = 0.013) climate scores (components of safety culture) 6-12 months after interprofessional simulation training. A growing body of literature suggests that a positive safety culture is associated with improved patient outcomes. Our study supports the implementation of point of care simulation as a useful intervention to improve safety culture in theatres

A self-monitoring wellbeing screening methodology for keyworkers, ‘My Personal Wellbeing’, using an integrative wellbeing model

Background The detrimental impact of Covid-19 has led to an urgent need to support the wellbeing of UK National Health Service and care workers. This research develops an online diary to support the wellbeing of staff in public healthcare in real-time, allowing the exploration of population wellbeing and pro-active responses to issues identified. Methods The diary was co-produced by NHS and care stakeholders and university researchers. It was based on an integrative model monitoring mental health symptoms as well as wellbeing indicators. Diary users were encouraged to reflect on their experience confidentially, empowering them to monitor their wellbeing. The data collected was analysed using Mann-Whitney-Wilcoxon and Kruskal-Wallis statistical tests to determine any significant wellbeing trends and issues. Results A statistically significant decline in wellbeing (P < 2.2E-16), and a significant increase in symptoms (P = 1.2E-14) was observed. For example, indicators of post-traumatic stress, including, flashbacks, dissociation, and bodily symptoms (Kruskal-Wallis P = 0.00081, 0.0083, and 0.027, respectively) became significantly worse and users reported issues with sleeping (51%), levels of alertness (46%), and burnout (41%). Conclusions The wellbeing diary indicated the value of providing ways to distinguish trends and wellbeing problems, thus, informing how staff wellbeing services can determine and respond to need with timely interventions. The results particularly emphasised the pressing need for interventions that help staff with burnout, self-compassion, and intrusive memories

An Integrated Frame-of-Reference for Modeling Management Systems

The application of any modelling method without reflection on the underpinning assumptions is flawed. What is more, such an approach is bound to lead us to an incomplete understanding of the situation under consideration, since it places "restrictions" on the ways we question the validity of the knowledge unearthed in the application of the method. Thus, creative interpretation becomes limited. The paper considers this problem. It draws on insights from cognitive science, autopoiesis, management cybernetics and non-linear dynamics and outlines a philosophical frame-of-reference for modelling management systems. It emphasises the importance of epistemological reflection and the need to consider modelling as a cognitive act that requires the inclusion of the observer as part of the inquiry and the development and use of a systemic language within the situation of concern

Using System Dynamics to Analyse Interactions in Duopoly Competition

This article introduces non-linear dynamics to assess the interactions in duopoly competition between two rivals. The generic competition is considered here to be the competition for quality between two consumer durable products. The authors have used a system dynamics approach to develop the model of interactions and simulate the behaviour over time. The outcomes of several hundred simulations have shown that the recognition and implementation lags in quality improvement strongly influence the qualitative behaviour of the system. When the speed of adaptation to customer demand reaches a certain value, a Hopf bifurcation occurs and the system converges into a limit cycle. Quasi-periodicity and chaos emerge when further increasing the speed of the response. Instead of tending to equilibrium around an optimal quality value the model exhibits complex counter-intuitive behaviours

Understanding emotional and health indicators underlying the burnout risk of healthcare workers

Background: Burnout of healthcare workers is of increasing concern as workload pressures mount. Burnout is usually conceptualised as resulting from external pressures rather than internal resilience and although is not a diagnosable condition, it is related to help seeking for its psychological sequelae. Objective: To understand how staff support services can intervene with staff heading for burnout, it is important to understand what other intrapsychic factors that are related to it. Methods: A diary tool was used by staff in a region of England to self monitor their wellbeing over time. The tool explores many areas of mental health and wellbeing and enabled regression analysis to predict which of the various factors predicted scores on the burnout item. Findings: Burnout can be best explained with independent variables including depression, receptiveness, mental wellbeing, and connectedness (p<0.05) using a multiple linear regression model. It was also shown that 71% of the variance present in the response variable, i.e. burnout, explained by independent variables. There is no evidence found for multicollinearity in our regression models confirmed by both the Spearman Rank Correlation and the Variance Inflation Factor methods. Conclusion: We showed how burnout can be explained using a handful number of factors including emotional and mental health indicators. Clinical implications: The findings suggest a simple set of items can predict burnout and could be used for screening. The data suggests attention to four factors around social safeness, grounding and care in the self, hope and meaning and having sufficient energy could form the basis of attention in weelbeing programs