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International audienceHealth care has evolved rapidly to meet the medical demands of society, but not to meet the demands of consistent operational safety. In other high risk domains in which the consequences of systems failure are unacceptable, organisational and operational work systems have been developed to deliver consistent, high-quality, failure-free performance. In this paper we review contributions to a special issue of Cognition, Technology and Work on ‘Enhancing Surgical Systems'. We consider their implications for improving the reliability of care processes in light of theoretical developments in the area of high-reliability organisations and resilience engineering. Health care must move from reactive safety cultures to be more proactively resilient to the continual threats posed by complexity in clinical care processes and the multi-professional hospital environment. Our analysis emphasises the importance of team working for reliable operational performance. A schematic framework to illustrate how safety interventions in surgery might cohere within an organisational strategy for achieving high-reliability is proposed. The implications for continuous quality improvement and effective regulation of system safety over differing time scales and organisational levels are discussed

Summary: Driving requires a combination of open-loop and closed-loop control. The open-loop control is affected by the quality of visual input, and therefore constrained during driving at night. This study investigated the effects of a Visual Enhancement System during simulated night driving conditions. It was hypothesised that the VES would improve the driver's control, hence the quality of driving. 40 Ss drove about 120 km on a simulated Swedish road with and without a VES. At the time of writing, the experiments have just finished. Data analysis will focus on derived measures that correspond to the driver's degree of control.

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