مراقبت‌های بهداشتی مقاوم، جلد دوم: تاب‌آوری کار بالینی روزمره (مطالعات اشگیت در مهندسی تاب‌آوری)

"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 This fails to recognise that this normative conception of work is often oversimplified, incomplete, and outdated.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 breaks new ground by analysing everyday work situations in primary, secondary, and tertiary care to identify and describe the fundamental strategies that clinicians everywhere have developed and use with a fluency that belies the demands to be resolved and the dilemmas to be balanced. Because everyday clinical work is at the heart of resilience, it is essential to appreciate how it functions, and to understand its characteristics"--EBL Analysing everyday work situations in primary, secondary, and tertiary care, this title identifies and describes the fundamental strategies that clinicians everywhere have developed and use with a fluency that belies the demands to be resolved and the dilemmas to be balanced. 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 Content: A lesson in resilience : the 2011 Stanley Cup riot / Garth S. Hunte -- Translating tensions into safe practices through dynamic trade-offs : the secret second handover / Mark A. Sujan, Peter Spurgeon and Matthew W. Cooke -- Workarounds in nursing practice in acute care : a case of health care arms race? / Deborah Debono and Jeffrey Braithwaite -- The demands imposed by a health care reform on clinical work in transitional care of the elderly : a multi-faceted Janus / Kristin Laugaland and Karina Aase -- The Stockholm blizzard of 2012 / Mirjam Ekstedt and Richard I. Cook -- Individual-collective trade-offs : implications for resilience / Robert L. Wears, Christiane C. Schubert and Garth S. Hunte -- Managing medicines management : organisational resilience in community pharmacies / Denham Phipps, Darren Ashcroft and Dianne Parker -- Blood transfusion with health information technology in emergency settings from a safety-II perspective / Kazue Nakajima -- Exposing hidden aspects of resilience and brittleness in everyday clinical practice using network theories / Jeffrey Braithwaite and Jennifer Plumb -- Patient boarding in the emergency department as a symptom of complexity-induced risks / Robert J. Stephens, David D. Woods and Emily S. Patterson -- Looking for patterns in everyday clinical work / Erik Hollnagel -- Tempest in a teapot : standardisation and workarounds within everyday clinical work / Shawna J. Perry and Rollin J. Fairbanks -- ECW in complex adaptive systems / Rob Robson -- Revealing resilience through critical incident narratives : a way to move from safety-I to safety-II / Sam Sheps, Karen Cardiff, Elaine Pelletier and Rob Robson -- Patients as a source of resilience / Christiane C. Schubert, Robert L. Wears, Richard J. Holden and Garth S. Hunte -- Strategies to get resilience into everyday clinical work / Sheuwen Chuang and Robert L. Wears -- Mobilising resilience by monitoring the right things for the right people at the right time / Al Ross and Janet Anderson -- Why is work-as-imagined different from work-as-done? / Erik Hollnagel. Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have concepts and methods that are able to cope with this complexity. Resilience engineering provides that capacity because its focus is on a system's overall ability to sustain required operations under both expected and unexpected conditions rather than on individual features or qualities. Resilience engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering. Whereas current safety approaches primarily aim to reduce or eliminate the number of things that go wrong, Resilient Health Care aims to increase and improve the number of things that go right. Just as the WHO argues that health is more than the absence of illness, so does Resilient Health Care argue that safety is more than the absence of risk and accidents. This can be achieved by making use of the concrete experiences of resilience engineering, both conceptually (ways of thinking) and practically (ways of acting). Properly performing health care systems require concepts and methods that match their complexity. Resilience engineering provides that capability. It focuses on a system's overall ability to sustain required operations under both expected and unexpected conditions rather than on individual features or qualities. This book contains contributions from international experts in health care, organisational studies and patient safety, as well as resilience engineering. Whereas current safety approaches primarily aim to reduce the number of things that go wrong, Resilient Health Care aims to increase