Development of New Methods to Support Systemic Incident Analysis.

PhDExplaining incidents as systems is a fast growing area of safety scientific research. The misleading conception of naturalistic human communication in terms of ‘objective information’ remains a pervasive influence on systemic explanation of incidents, despite over a decade of methodological developments in the area. Currently, interested stakeholders are offered with few alternatives for analysing how information systems emerge naturally, and contribute towards the structuring of incident situations. Extant methods are also yet to be widely adopted by the practitioner community, and a research-practice gap has formed. In this PhD research, a new method of systemic incident analysis is developed, to counterbalance against the extant methods being developed in the area. The new method draws on insights from both Distributed Cognition, and linguistics research, in order to present a distributed means of doing systemic incident analysis. The new method de-objectifies the notion of information, to support analysis of how information ‘flow’ is constitutive of the formation of distributed cognitive systems. In embedding an intersubjective component into the core method design, we aim to increase the likelihood of systematic learning from incident situations. The incident analyst is required to explicitly relate past explanations of incident situations, in detail, to data and hypotheses from new incident situations. To increase the potential for theorists in the area to better account for the demands of incident analysis as practiced, data, insights, and method are contributed towards the bridges been built between research and practice. We first develop additional understanding of the practice of incident analysts from the patient safety background. Next, we provide a second new method of analysis, to allow research scrutiny of the empirical phenomena of using systemic incident analysis methods. This second method considers the detailed relationship: from the theory of the systemic incident analysis method into its practice as part of real incident investigation. This provides a new research instrument, for systematically examining how systemic incident analysis methods may afford or constrain elements of their practice.EPSRC CHI+MED project (http://www.chi-med.ac.uk/, EP/G059063/1)

Virtual Element Methods Without Extrinsic Stabilization

Virtual element methods (VEMs) without extrinsic stabilization in arbitrary degree of polynomial are developed for second order elliptic problems, including a nonconforming VEM and a conforming VEM in arbitrary dimension under the mesh assumption that all the faces of each polytope are simplices. The key is to construct local $H({\rm div})$-conforming macro finite element spaces such that the associated $L^2$ projection of the gradient of virtual element functions is computable, and the $L^2$ projector has a uniform lower bound on the gradient of virtual element function spaces in $L^2$ norm. Optimal error estimates are derived for these VEMs. Numerical experiments are provided to test the VEMs without extrinsic stabilization.Comment: 25 pages, 8 figure

Learning from incidents in health care : critique from a Safety-II perspective

Patients are continually being put at risk of harm, and health care organisations are struggling to learn effectively from past experiences in order to improve the safe delivery and management of care. Learning from incidents in health care is based on the traditional safety-engineering paradigm, where safety is defined by the absence of negative events (Safety-I). In this paper we make suggestions for the policy and practice of learning from incidents in health care by offering a critique based on a Safety-II perspective. In Safety-II thinking safety is defined as an ability - to make dynamic trade-offs and to adjust performance in order to meet changing demands and to deal with disturbances and surprises. The paper argues that health care organisations might improve their ability to learn from past experience by studying not only what goes wrong (i.e. incidents), but also by considering what goes right, i.e. by learning from everyday clinical work

Geometric Decomposition and Efficient Implementation of High Order Face and Edge Elements

This paper delves into the world of high-order curl and div elements within finite element methods, providing valuable insights into their geometric properties, indexing management, and practical implementation considerations. It first explores the decomposition of Lagrange finite elements. The discussion then extends to H(div)-conforming finite elements and H(curl)-conforming finite element spaces by choosing different frames at different sub-simplex. The required tangential continuity or normal continuity will be imposed by appropriate choices of the tangential and normal basis. The paper concludes with a focus on efficient indexing management strategies for degrees of freedom, offering practical guidance to researchers and engineers. It serves as a comprehensive resource that bridges the gap between theory and practice in the realm of high-order curl and div elements in finite element methods, which are vital for solving vector field problems and understanding electromagnetic phenomena.Comment: 25 pages, 8 figure

Capturing the distinction between task and device errors in a formal model of user behaviour

In any complex interactive human-computer system, people are likely to make errors during its operation. In this paper, we describe a validation study of an existing generic model of user behaviour. The study is based on the data and conclusions from an independent prior experiment. We show that the current model does successfully capture the key concepts investigated in the experiment, particularly relating to results to do with the distinction between task and device-specific errors. However, we also highlight some apparent weaknesses in the current model with respect to initialisation errors, based on comparison with previously unpublished (and more detailed) data from the experiment. The differences between data and observed model behaviour suggest the need for new empirical research to determine what additional factors are at work. We also discuss the potential use of formal models of user behaviour in both informing, and generating further hypotheses about the causes of human error

Using Self-Determination Theory in research and evaluation in primary care

BACKGROUND: Multimorbidity (the co‐existence of two or more long‐term conditions within an individual) is a complex management challenge, with a very limited evidence base. Theories can help in the design and operationalization of complex interventions. OBJECTIVE: This article proposes self‐determination theory (SDT) as a candidate theory for the development and evaluation of interventions in multimorbidity. METHODS: We provide an overview of SDT, its use in research to date, and its potential utility in complex interventions for patients with multimorbidity based on the new MRC framework. RESULTS: SDT‐based interventions have mainly focused on health behaviour change in the primary prevention of disease, with limited use in primary care and chronic conditions management. However, SDT may be a useful candidate theory in informing complex intervention development and evaluation, both in randomized controlled trials and in evaluations of ‘natural experiments’. We illustrate how it could be used multimorbidity interventions in primary care by drawing on the example of CARE Plus (a primary care‐based complex intervention for patients with multimorbidity in deprived areas of Scotland). CONCLUSIONS: SDT may have utility in both the design and evaluation of complex interventions for multimorbidity. Further research is required to establish its usefulness, and limitations, compared with other candidate theories. PATIENT OR PUBLIC CONTRIBUTION: Our funded research programme, of which this paper is an early output, has a newly embedded patient and public involvement group of four members with lived experience of long‐term conditions and/or of being informal carers. They read and commented on the draft manuscript and made useful suggestions on the text. They will be fully involved at all stages in the rest of the programme of research