Improving performance reliability in surgical systems |
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Authors: | Email author" target="_blank">J?BennEmail author A?N?Healey E?Hollnagel |
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Affiliation: | 1.Clinical Safety Research Unit, Department of Biosurgery and Surgical Technology, Imperial College London,St Mary’s Hospital,London,England, UK;2.Link?pings Universitet,Link?ping,Sweden |
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Abstract: | Health care has evolved rapidly to meet the medical demands of society, but not to meet the demands of consistent operational
safety. In other high risk domains in which the consequences of systems failure are unacceptable, organisational and operational
work systems have been developed to deliver consistent, high-quality, failure-free performance. In this paper we review contributions
to a special issue of Cognition, Technology and Work on ‘Enhancing Surgical Systems’. We consider their implications for improving
the reliability of care processes in light of theoretical developments in the area of high-reliability organisations and resilience
engineering. Health care must move from reactive safety cultures to be more proactively resilient to the continual threats
posed by complexity in clinical care processes and the multi-professional hospital environment. Our analysis emphasises the
importance of team working for reliable operational performance. A schematic framework to illustrate how safety interventions
in surgery might cohere within an organisational strategy for achieving high-reliability is proposed. The implications for
continuous quality improvement and effective regulation of system safety over differing time scales and organisational levels
are discussed. |
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Keywords: | High-reliability organisations Reliability Health care systems Continuous quality improvement Safety management Surgery Teams Resilience engineering |
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