Another (Swedish) presentation: Aspects of Patient Safety

Dear readers, I am about to give another presentation so of course I am sharing it with you. Feels like posting presentations is the only thing I do at the moment (well, I make them and I give them as well). However this is a rather big one and I will give it four times before the end of the year. Tomorrow will be the first one and the audience will be a rather decent number of junior doctors from the Sörmland-area (where I was born and raised!) in Sweden. The three following occasions will all be held in Lund. I'll give you the presentation, followed by some comments below.

The rhetoric outline of the presentation is (as you know if you have walked through others) a favorite: outlining different perspectives and follow their scientific roots and how they apply to the "real" (whatever that is) world. Of course one view will be presented as old and dirty and the other as new, inspiring and making a lot of sense :) The old and dirty view of patient safety is the (left) one deriving accidents to the fallibility of unreliable human beings and success to the human heroes. In the presentation I argue (based on Sidney Dekker's theoretical writings) for this view being based on a Newtonian-Cartesian world view in which organizations are described using the machine-metaphore deriving performance reliability (the main goal of a machine) to the performance of the constituent components (in the organization being the people). Following this view sorting out the bad apples (the unreliable components) from the system makes a lot of sense and "human error" is a reasonable conclusion in the wake of an accident.

The second (and much better) view outlined is based on complexity theory and the humanistic assumption that nobody goes to work to do a bad job. No pilot wants her plane to crash and no nurse want his patient to die as a result of an accident. From complexity theory we also learn that accidents can happen when everyone do as they are expected to. In complex organizations the tight couplings and interdependencies can result in system behavior that is not reducible to the behavior of the constituent actors. Safety then becomes a system property emerging from the interaction between actors, not from the reliability of the individual actors (people).

Based on this complexity-view of safety I will outline ideas of how to respond to accidents. How to hold people accountable for the safety of the system without risking a silent system. That discussion will peak with the idea of accountability defined in terms of accountability for learning ("I hold you accountable by listening to your story and I expect you to tell me your story so that we can learn an improve").

The final part of the talk will follow the idea that safety happens in organizational interaction. How can we practice good interaction and successful coordination between doctors, nurses, wards and machines? We will discuss the notions of communication, leadership and decision making before ending the talk.

I hope you will have fun clicking around the presentation! Don't hesitate to write comments if you have any questions or remarks. 


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