Towards safer, better healthcare: harnessing the natural properties of complex sociotechnical systems

Objectives: To sustain an argument that harnessing the natural properties of sociotechnical systems is necessary to promote safer, better healthcare. Methods: Triangulated analyses of discrete literature sources, particularly drawing on those from mathematics, sociology, marketing science and psychology. Results: Progress involves the use of natural networks and exploiting features such as their scale-free and small world nature, as well as characteristics of group dynamics like natural appeal (stickiness) and propagation (tipping points). The agenda for change should be set by prioritising problems in natural categories, addressed by groups who self select on the basis of their natural interest in the areas in question, and who set clinical standards and develop tools, the use of which should be monitored by peers. This approach will facilitate the evidence-based practice that most agree is now overdue, but which has not yet been realised by the application of conventional methods. Conclusion: A key to health system transformation may lie under-recognised under our noses, and involves exploiting the naturally-occurring characteristics of complex systems. Current strategies to address healthcare problems are insufficient. Clinicians work best when their expertise is mobilised, and they flourish in groupings of their own interests and preference. Being invited, empowered and nurtured rather than directed, micromanaged and controlled through a hierarchy is preferable.5 page(s

The pure effect of social preferences on regional location choices: The evolving dynamics of convergence to a steady state population distribution

This paper tracks the consequences of individuals’ desire to align their location with their social preferences. The social preference studied in the paper is distaste for relative deprivation, measured in a cardinal manner. Location is conceived as social space, with individuals choosing to relocate if, as a result, their relative deprivation will be reduced, holding their incomes constant. Conditions are provided under which the associated dynamics reaches a spatial steady state, the number of periods it takes to reach a steady state is specified, and light is shed on the robustness of the steady state outcome. By way of simulation it is shown that for large populations, a steady state of the relocation dynamics is almost always reached, typically in one period, and that cycles are more likely to occur when the populations’ income distributions are more equal

Patient safety's missing link: using clinical expertise to recognize, respond to and reduce risks at a population level

Introduction: Although incident reporting systems are widespread in health care as a strategy to reduce harm to patients, the focus has been on reporting incidents rather than responding to them. Systems containing large numbers of incidents are uniquely placed to raise awareness of, and then characterize and respond to infrequent, but significant risks. The aim of this paper is to outline a framework for the surveillance of such risks, their systematic analysis, and for the development and dissemination of population-based preventive and corrective strategies using clinical and human factors expertise. Requirements for a population-level response: The framework outlines four system requirements: to report incidents; to aggregate them; to support and conduct a risk surveillance, review and response process; and to disseminate recommendations. Personnel requirements include a non-hierarchical multidisciplinary team comprising clinicians and subject-matter and human factors experts to provide interpretation and high-level judgement from a range of perspectives. The risk surveillance, review and response process includes searching of large incident and other databases for how and why things have gone wrong, narrative analysis by clinical experts, consultation with the health care sector, and development and pilot testing of corrective strategies. Criteria for deciding which incidents require a population-level response are outlined. Discussion: The incremental cost of a population-based response function is modest compared with the 'reporting' element. Combining clinical and human factors expertise and a systematic approach underpins the creation of credible risk identification processes and the development of preventive and corrective strategies.Peter D. Hibbert, Frances Healey, Tara Lamont, William M. Marela, Bruce Warner and William B. Runcima

Who is to blame? The relationship between ingroup identification and relative deprivation is moderated by ingroup attributions

Contradictory evidence can be found in the literature about whether ingroup identification and perceived relative deprivation are positively or negatively related. Indeed, theoretical arguments can be made for both effects. It was proposed that the contradictory findings can be explained by considering a hitherto unstudied moderator: The extent to which deprivation is attributed to the ingroup. It was hypothesised that identification would only have a negative impact on deprivation, and that deprivation would only have a negative impact on identification, if ingroup attributions are high. To test this, attributions to the ingroup were experimentally manipulated among British student participants (N = 189) who were asked about their perceived deprivation vis-à-vis German students, yield ing support for the hypotheses

Does wage rank affect employees' well-being?

How do workers make wage comparisons? Both an experimental study and an analysis of 16,000 British employees are reported. Satisfaction and well-being levels are shown to depend on more than simple relative pay. They depend upon the ordinal rank of an individual's wage within a comparison group. “Rank” itself thus seems to matter to human beings. Moreover, consistent with psychological theory, quits in a workplace are correlated with pay distribution skewness

Re-Examining the Frustrated Homemaker Hypothesis

Multiple Classification Analyses on responses from 946 white women, drawn from the 1972 American National Election Study survey, were used to test the "frustrated homemaker hypothesis" that full-time homemakers are more dissatisfied with their lives than women employed outside the home. The fit between actual and desired roles proved to be a better predictor of personal satisfaction than the traditional dichotomy between homemakers and employed women. Homemakers who had wanted a career were more personally dissatisfied than homemakers who had never wanted a career. The career-oriented homemakers were the ones who expressed greater personal dissatisfaction than employed women. Employed women and career-oriented homemakers were about equally critical of women's collective position in society, while homemakers who had never wanted a career were more accepting of women's status quo. The importance of including evaluations of both personal and collective well-being was shown by the fact that these two domains bore different relationships to employment-homemaker status.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69078/2/10.1177_073088848100800404.pd