Resilient Health Care, Volume 2

The Resilience of Everyday Clinical Work

Robert L. Wears, Erik Hollnagel

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781317065142
• Edition: 1
• Topic: Política y relaciones internacionales
• Subtopic: Relaciones laborales e industriales

Health systems everywhere are expected to meet increasing public and political demands for accessible, high-quality care. Policy-makers, managers, and clinicians use their best efforts to improve efficiency, safety, quality, and economic viability. One solution has been to mimic approaches that have been shown to work in other domains, such as quality management, lean production, and high reliability. In the enthusiasm for such solutions, scant attention has been paid to the fact that health care as a multifaceted system differs significantly from most traditional industries. Solutions based on linear thinking in engineered systems do not work well in complicated, multi-stakeholder non-engineered systems, of which health care is a leading example. A prerequisite for improving health care and making it more resilient is that the nature of everyday clinical work be well understood. Yet the focus of the majority of policy or management solutions, as well as that of accreditation and regulation, is work as it ought to be (also known as 'work-as-imagined'). The aim of policy-makers and managers, whether the priority is safety, quality, or efficiency, is therefore to make everyday clinical work - or work-as-done - comply with work-as-imagined. This fails to recognise that this normative conception of work is often oversimplified, incomplete, and outdated. There is therefore an urgent need to better understand everyday clinical work as it is done. Despite the common focus on deviations and failures, it is undeniable that clinical work goes right far more often than it goes wrong, and that we only can make it better if we understand how this happens. This second volume of Resilient Health Care continues the line of thinking of the first book, but takes it further through a range of chapters from leading international thinkers on resilience and health care. Where the first book provided the rationale and basic concepts of RHC, the Resilience of Everyday Clinical Work b

Table of contents

• Cover
• Contents
• List of Figures
• List of Tables
• About the Editors
• Author Biographies
• Preface
• 1 A Lesson in Resilience: the 2011 Stanley Cup Riot
• 2 Translating Tensions into Safe Practices Through Dynamic Trade-offs: the Secret Second
• 3 Workarounds in Nursing Practice in Acute Care: a Case of a Health Care Arms Race?
• 4 The Demands Imposed by a Health Care Reform on Clinical Work in Transitional Care
• 5 The Stockholm Blizzard of 2012
• 6 Individual-collective Trade-offs: Implications for Resilience
• 7 Managing Medicines Management: Organisational Resilience in Community Pharmacies
• 8 Blood Transfusion with Health Information Technology in Emergency Settings from
• 9 Exposing Hidden Aspects of Resilience and Brittleness in Everyday Clinical Practice Using
• 10 Patient Boarding in the Emergency Department as a Symptom of Complexity-induced Risks
• 11 Looking for Patterns in Everyday Clinical Work
• 12 Tempest in a Teapot: Standardisation and Workarounds in Everyday Clinical Work
• 13 ECW in Complex Adaptive Systems
• 14 Revealing Resilience through Critical Incident Narratives: a Way to Move from
• 15 Patients as a Source of Resilience
• 16 Strategies to Get Resilience into Everyday Clinical Work
• 17 Mobilising Resilience by Monitoring the Right Things for the Right People at the Right
• 18 Why is Work-as-Imagined Different from Work-as-Done?
• Bibliography
• Index