Understanding complexity in a safety critical setting: A systems approach to medication administration.

'Medication errors' are a significant concern and are associated with a higher incidence of adverse events and unintentional patient harm than any other aspect of healthcare. While much research has focused on adverse medication errors, limited studies have specifically examined 'normal' medication delivery performance and the interactions between tasks, agents, and information within the medication administration system. This article describes a study that applied the Event Analysis of Systemic Teamwork (EAST) model to study the hospital medication administration system to identify opportunities to optimise performance and patient safety. Key findings of this study demonstrate that this is a highly complex system, comprising many social agents and a relatively closely linked series of tasks and information. However, most of the workload relies on a small proportion of healthcare professionals. Significantly, the patient has a minimal role in the medication administration system during their hospital stay. The research has shown that this approach enables mapping networks and their interdependencies to optimise the system as a whole rather than its parts in isolation.

The impact of power on health care team performance and patient safety: a review of the literature.

Communication failure within health care teams is a major cause of patient harm across health care settings. Factors which contribute to communication failure include actual or perceived 'power'. Whilst a great deal of ergonomics research has focussed on teamwork in health care, the role of power in relation to measurable patient safety and performance outcomes remains relatively unknown. This article presents the findings from a review of the literature on power within multidisciplinary health care team settings. Following a systematic literature search, nineteen studies were evaluated in terms of research design, methods and analyses across the included studies. The main impacts resulting from power imbalances include negative effects on team collaboration, decision-making, communication and overall performance. Wider patient safety research, and more specifically the ergonomics discipline, is encouraged to address the complex interplay between power and teamwork in the health care sector.Practitioner Statement: We conducted a review of studies focussed on the influence of power on teamwork in health care. The findings show that power can have negative impacts on collaboration, decision-making, communication, and team performance. We conclude that power represents an important area for ergonomics, both in health care and other settings.Abbreviations: CRM: crew resource management; TEM: threat and error management; SNA: social network analysis; EAST: event analysis of systemic teamwork.

Walking the talk: Comparing pedestrian 'activity as imagined' with 'activity as done'.

The safety of vulnerable road users, including pedestrians, is an important issue worldwide. In line with the shift towards systems thinking in transport safety, the aim of this study was to compare the normal performance of pedestrians as they navigate the road system with that imagined by road system managers to gain insights into how safety management can be improved for this vulnerable road user group. The Event Analysis of Systemic Teamwork framework was used to compare pedestrian activity 'as imagined' and 'as done' at signalised road intersections and railway level crossings. Data regarding 'activity as imagined' was derived from documentation review, and data on 'activity as done' was derived from a semi-naturalistic study of ten participants. It is concluded that in both environments pedestrians exhibited more diversity and variability than anticipated by system managers. Insights for improving the design of the road environment for pedestrians are provided. Further, it is argued that wider changes to the processes used in the design and management of road systems are needed.