Safer Healthcare by Charles Vincent & René Amalberti

Author:Charles Vincent & René Amalberti
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Staff in all environments rely on workarounds such as obtaining information from patients rather than their health records, or using disposable gloves as tourniquets. In some cases, risks are taken such as making clinical decisions without information, or transferring used sharps to sharps bins in remote locations (Burnett et al. 2011). Often front-line coping and adaptation leads to short-term “fixes” that put off more fundamental, long-term solutions. These clinical work-arounds may also allow managers to protect themselves from inconvenient truths and shift accountability for failure to front-line workers (Wears and Vincent 2013).

We therefore always need to think, when formulating the overall approach to safety, both about what the approach is now and what might be the most effective strategy in the longer term. We certainly believe that adaptive strategies should be further developed in the sense of being planned and to some extent formalised. However this is very different from the current reliance on ad hoc improvising to compensate for missing information, faulty equipment and the like. Figure 7.1 illustrates these ideas in the context of acute medicine suggesting that increasing reliability and controlling flow and demand would reduce the need for adaptation and improvisation. With this in mind we now illustrate the five safety strategies in the context of the hospital; we devote most space to risk control, adaptation and mitigation as the other two strategies are already well described.

Fig. 7.1Improving systems reduces the need for adaptation

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