Modernising patient safety: Reconciling work imagined and work done

Groups related to this event

Centre for Healthcare Resilience and Implementation Science

Event date

Thursday, 7 July 2016

Professor Jeffrey Braithwaite, founding Director, AIHI. View the seminar video.

Abstract

Every day people go to work and develop a work plan. This is a list, either written or in their heads, of what they hope to accomplish that day. But when people get to the end of the day, they all-too-often find that they did not accomplish everything they planned they would, and indeed their day wasn’t anything like how they’d imagined it. This distinction, between work-as-imagined (WAI) and work-as-done (WAD), is everywhere. Individuals doing their workplans are a general case of a specific cadre of people whose role it is to influence how work gets done. This includes policymakers, executives, managers, legislators, governments, boards of directors, software designers, safety regulation agencies, teachers, and researchers. These people and groups are the blunt end of the system. What they do in trying to shape, influence and nudge behaviour seems perfectly logical, obvious and feasible. They ask people at the sharp end of the system, and sometimes mandate or prescribe to them, to follow the rules. To make things safer for patients, those doing WAI have designed, mandated or encouraged a bewildering range of tools, techniques and methods to reduce harm to patients, including root cause analysis, hand hygiene campaigns, FMEA, and the like. Yet, over the last 25 years the rates of harm to patients have not reduced much: adverse events continue to run at about 10% of all episodes of care.

Meanwhile, work is getting done, often despite all the policies, rules and prescriptions. At the sharp end, people are doing work under fragmented, complex, resource-constrained and challenging circumstances. To accomplish their tasks, they flex and adjust their practices to the circumstances. They don’t deliver care in the way blunt end prescriptive want them to, or suggest they should. And the way clinicians delivering care do their work does not look like the pristine, logical world proposed by the WAI proponents. It never unfolds like a policy or procedure says it should. Despite this variation and natural coal-face adjustments, things go right far more often than they go wrong.

In complex adaptive health systems, we need to figure out ways to reconcile WAI and WAD. This would be a system where WAI policies, regulations and standards are much closer to an understanding of how work is actually done, and one in which WAD practitioners have a better appreciation of what WAI proponents are trying to do in establishing regulatory regimes.

In this talk we discuss the responsibilities of both the blunt end and the sharp end people and figure out ways to reconcile the two worldviews. Recently, the US Institute of Medicine report released a landmark report “Improving Diagnosis in Health Care” highlighting the important problem of diagnostic errors in health care.  The speaker will first present a brief overview of key concepts needed to understand and reduce diagnostic errors in current electronic health record-enabled care settings. This will be followed by discussion on certain types of diagnostic errors, such as from breakdowns in follow-up of abnormal test results, as well as potential solutions for mitigating diagnostic safety risks.

Speaker profile

Professor Jeffrey Braithwaite, BA, MIR (Hons), MBA, DipLR, PhD, FAIM, FCHSM, FFPHRCP (UK), FAcSS (UK), is Foundation Director, Australian Institute of Health Innovation, Director, Centre for Healthcare Resilience and Implementation Science, and Professor of Health Systems Research, Faculty of Medicine and Health Sciences, Macquarie University. His research examines the changing nature of health systems, attracting funding of more than AUD$90 million (EUR€58 million, GBP£45 million).

He has contributed over 600 total publications presented at international and national conferences on more than 800 occasions, including 80 keynote addresses. His research appears in journals such as British Medical Journal, The Lancet, Social Science & Medicine, BMJ Quality and Safety, and International Journal of Quality in Health Care. He has received numerous national and international awards for his teaching and research.

Further details are available at his Wikipedia entry: http://en.wikipedia.org/wiki/Jeffrey_Braithwaite.

He is also very interested in the Anthropocene and the impact of human activity on human and species’ health, population and climate. He blogsat http://www.jeffreybraithwaite.com/new-blog/

Seminar details

Date: Thursday 7 July 2016

Time: 12pm - 1pm

Venue: Seminar Room, Level 1, 75 Talavera Road, Macquarie University

Chairperson: Professor Johanna Westbrook

To register for this seminar please click here

Further reading

1. Braithwaite J, Clay-Williams R, Nugus P, Plumb J: Health care as a complex adaptive system. In: Hollnagel E, Braithwaite J, Wears R (eds). Resilient health care. Surrey, UK: Ashgate Publishing Limited, 2013.
2. Braithwaite J, Coiera E. Beyond patient safety flatland. Journal of the Royal Society of Medicine 2010, 103: 219-225.
3. Braithwaite, J., Wears, R. and Hollnagel, E. (eds) (In Press) Resilient Health Care Vol. 3: Reconciling Work-as-Imagined and Work-as-Done, Abingdon, UK; Taylor and Francis.
4. Braithwaite, J., Wears, R.L. and Hollnagel, E. (2015) Resilient health care: turning patient safety on its head. International Journal for Quality in Health Care, 27(5). doi: 10.1093/intqhc/mzv063. [http://intqhc.oxfordjournals.org/content/early/2015/08/19/intqhc.mzv063].
5. Hollnagel E, Braithwaite J, Wears R (eds). Resilient health care. Surrey, UK: Ashgate Publishing Limited, 2013.
6. Hollnagel, E., Wears, R.L. and Braithwaite, J. (2015) From Safety-I to Safety-II: a white paper. The Resilient Health Care Net: Published simultaneously by the University of Southern Denmark, University of Florida, USA, and Macquarie University, Australia. [https://aihi.mq.edu.au/sites/default/files/aihi/resources/From_Safety_I_....
7. Wears, R., Hollnagel, E. and Braithwaite, J. (eds) (2015) Resilient Health Care Vol. 2: The resilience of everyday clinical work, Farnham, Surrey, Ashgate Publishing Ltd. ISBN: 978-1-4724-3782-2.