Beyond patient safety Flatland

Braithwaite, Jeffrey; Coiera, Enrico

doi:10.1258/jrsm.2010.100032

Cited by 23 publications

(16 citation statements)

References 59 publications

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“…Sociology dispels this illusion of control. Instead it has shown the need to unravel the multiple dimensions of quality and safety (Braithwaite and Coiera , Dixon‐Woods ), and apprehend its context‐bound nature (Plumb ) in which quality and safety are understood as emergent products of distributed stakeholder relationships and assemblages of people, materials and ideas (Latour , Mol ). In this view safety and quality are multiple and contested ‘processes‐in‐the‐making’ rather than static states or concrete edifices amenable to external manipulation.…”

Section: Discussionmentioning

confidence: 99%

Healthcare quality and safety: a review of policy, practice and research

Waring

Allen

Braithwaite

et al. 2015

Sociology Health & Illness

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Over the last two decades healthcare quality and safety have risen to the fore of health policy and research. This has largely been informed by theoretical and empirical ideas found in the fields of ergonomics and human factors. These have enabled significant advances in our understanding and management of quality and safety. However, a parallel and at time neglected sociological literature on clinical quality and safety is presented as offering additional, complementary, and at times critical insights on the problems of quality and safety. This review explores the development and contributions of both the mainstream and more sociological approaches to safety. It shows that where mainstream approaches often focus on the influence of human and local environment factors in shaping quality, a sociological perspective can deepen knowledge of the wider social, cultural and political factors that contextualise the clinical micro-system. It suggests these different perspectives can easily complement one another, offering a more developed and layered understanding of quality and safety. It also suggests that the sociological literature can bring to light important questions about the limits of the more mainstream approaches and ask critical questions about the role of social inequality, power and control in the framing of quality and safety.

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Section: Discussionmentioning

confidence: 99%

Healthcare quality and safety: a review of policy, practice and research

Waring

Allen

Braithwaite

et al. 2015

Sociology Health & Illness

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“…The applications for AR annotation in clinical practice may be extensive. It is well known for example, that patients are at risk of iatrogenic harm, and reducing the rates of errors remains an elusive goal 34. Prompts and reminders in augmented space could be used to do anything from encouraging hand washing to preventing wrong-side surgery (box 1).…”

Section: Discussionmentioning

confidence: 99%

Communication spaces

Coiera¹

2014

J Am Med Inform Assoc

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Background and objectiveAnnotations to physical workspaces such as signs and notes are ubiquitous. When densely annotated, work areas become communication spaces. This study aims to characterize the types and purpose of such annotations.MethodsA qualitative observational study was undertaken in two wards and the radiology department of a 440-bed metropolitan teaching hospital. Images were purposefully sampled; 39 were analyzed after excluding inferior images.ResultsAnnotation functions included signaling identity, location, capability, status, availability, and operation. They encoded data, rules or procedural descriptions. Most aggregated into groups that either created a workflow by referencing each other, supported a common workflow without reference to each other, or were heterogeneous, referring to many workflows. Higher-level assemblies of such groupings were also observed.DiscussionAnnotations make visible the gap between work done and the capability of a space to support work. Annotations are repairs of an environment, improving fitness for purpose, fixing inadequacy in design, or meeting emergent needs. Annotations thus record the missing information needed to undertake tasks, typically added post-implemented. Measuring annotation levels post-implementation could help assess the fit of technology to task. Physical and digital spaces could meet broader user needs by formally supporting user customization, ‘programming through annotation’. Augmented reality systems could also directly support annotation, addressing existing information gaps, and enhancing work with context sensitive annotation.ConclusionsCommunication spaces offer a model of how work unfolds. Annotations make visible local adaptation that makes technology fit for purpose post-implementation and suggest an important role for annotatable information systems and digital augmentation of the physical environment.

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“…Despite the growth of an impressive patient safety industry2 with many activities including incident reporting, root cause analysis and hand hygiene initiatives, there seems to have been limited impact on the incidence of mortality or reductions in the rates of adverse events 3…”

Section: Rapid Response: a Hospital-wide Success Storymentioning

confidence: 99%

‘Between the flags’: implementing a rapid response system at scale

et al. 2014

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While many hospitals are implementing rapid response systems (RRSs) to attend to deteriorating patients in a systematic way, there is little documented evidence on system-wide approaches to adopting RRSs. Here, we report on an initiative which enrolled 220 hospitals in New South Wales, Australia. The 'between the flags' approach was modelled on Australia's surf lifesaving experience, where qualified lifesavers perform thousands of rescues each year. Patients in hospitals who are identified as being 'between the flags' are given special attention, just like beach goers.

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Beyond patient safety Flatland

Cited by 23 publications

References 59 publications

Healthcare quality and safety: a review of policy, practice and research

Healthcare quality and safety: a review of policy, practice and research

Communication spaces

‘Between the flags’: implementing a rapid response system at scale

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