The social process of escalation: a promising focus for crisis management research

Abstract

Background This study identifies a promising, new focus for the crisis management research in the health care domain. After reviewing the literature on health care crisis management, there seems to be a knowledge-gap regarding organisational change and adaption, especially when health care situations goes from normal, to non-normal, to pathological and further into a state of emergency or crisis. Discussion Based on studies of escalating situations in obstetric care it is suggested that two theoretical perspectives (contingency theory and the idea of failure as a result of incomplete interaction) tend to simplify the issue of escalation rather than attend to its complexities (including the various power relations among the stakeholders involved). However studying the process of escalation as inherently complex and social allows us to see the definition of a situation as normal or non-normal as an exercise of power in itself, rather than representing a putatively correct response to a particular emergency. Implications The concept of escalation, when treated this way, can help us further the analysis of clinical and institutional acts and competence. It can also turn our attention to some important elements in a class of social phenomenon, crises and emergencies, that so far have not received the attention they deserve. Focusing on organisational choreography, that interplay of potential factors such as power, professional identity, organisational accountability, and experience, is not only a promising focus for future naturalistic research but also for developing more pragmatic strategies that can enhance organisational coordination and response in complex events.

Acting between guidelines and reality. Managers’ balancing between standardisation and adaptive behaviour in patient safety work- an interview study

“…Both when scheduling shifts but also in guiding investments in their continuous learning and development. Making such early investments in the competencies of front-line staff have been highlighted as important for creating capacity for staff to be able to notice risks and as a precondition for organisational resilience [18].…”

User acceptance of observation and response charts with a track and trigger system: a multisite staff survey

“…, Bergstrom et al . ), a highly charged professional space particularly within the context of a deteriorating patient (Mackintosh et al . ).…”

Acting between Checklists and Reality. Managers’ Balancing between Standardization and Adaptive Behaviour in Patient Safety Work- an Interview Study

“…Both when scheduling shifts but also in guiding investments in their continuous learning and development. Making such early investments in the competencies of front-line staff have been highlighted as important for creating capacity for staff to be able to notice risks and respond resiliently [16]. The managers' focus on scheduling the right competencies can be seen as an important precondition for the team's capability to manage everyday work as well as to reorganise and respond to a variety of expected and unexpected situations in the complex ICU environment.…”