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The subject of this licentiate thesis is experience feedback from accidents and incidents. The thesis aims to contribute to an understanding of how the learning processes within organizations, companies and authorities could be improved. Essay I (written together with Sven Ove Hansson) reports on an evaluation carried out in 2004 by the Swedish Work Environment Authority’s Accident Investigation Board, called HAKO (Haverikommissionen). An important outcome of this evaluation shows that HAKO have not been able to manage the dissemination of their written reports, which is unfortunate, since the reports are thoroughly written. Essay II (written with Sven Ove Hansson and Carl Rollenhagen) is an overview of the literature on learning from accidents and incidents. The focus in this essay is on literature that evaluates the effectiveness and usefulness of different methods in accident investigations. The conclusions drawn from this literature review are that the dissemination of results and knowledge from accident investigations must be improved, and experience feedback systems should be integrated into overall systems of risk management. The starting point for Essay III was an empirical study conducted in 2005/2006. Twenty-eight supervision cases from eleven local Environment and Health Administrations in Sweden were examined. The overall goal of the study was to find out how, and to what extent, experience feedback occurs between different municipal authorities. Two major problems affecting experience feedback have been found; namely, that the inspectors do not have enough guidance on how to interpret the law, and that they would like more information on what happens to legal cases they have reported to public prosecutors and police. / QC 20101118

Emergency managers are often faced with the toughest decisions that can ever be made, people's lives hang in the balance. Nevertheless, these tough decisions have to be made, and made quickly. There is usually too much information to process to make the best decisions. Decision support systems can relieve a significant amount of this onus, making decision while considering the complex interweaving of constraints and resources that define the boundary of the problem. We study these complex emergency management, approaching the problem with discrete optimization. Using our operational research knowledge to model mass casualty incidents, we seek to provide solutions and insights for the emergency managers. This dissertation proposes a novel deterministic model to optimize the casualty transportation and treatment decisions in response to a MCI. This deterministic model expands on current state of the art by; (1) including multiple dynamic resources that impact the various interconnected decisions, (2) further refining a survival function to measure expected survivors, (3) defining novel objective functions that consider competing priorities, including maximizing survivors and balancing equity, and finally (4) developing a MCI response simulation that provides insights to how optimization models could be used as decision-support mechanisms. / Doctor of Philosophy / Emergency managers are often faced with the toughest decisions that can ever be made, people's lives hang in the balance. Nevertheless, these tough decisions have to be made, and made quickly. But to make the best decisions, there is usually too much information to process. Computers and support tools can relieve a significant amount of this onus, making decision while considering the complex interweaving of constraints and resources that define the boundary of the problem. This dissertation provides a mathematical model that relates the important decisions made during a MCI response with the limited resources of the surrounding area. This mathematical model can be used to determine the best response decisions, such as where to send casualties and when to treat them. This model is also used to explore ideas of fairness and equity in casualty outcomes and examine what may lead in unfair response decisions. Finally, this dissertation uses a simulation to understand how this model could be used to not only plan the response, but also update the plan as you learn new information during the response roll-out.

Traditional in lab usability evaluation has been used as the 'standard' evaluation method for evaluating and improving usability of software user interfaces (Andre, Williges, & Hartson, 2000). However, traditional in lab evaluation has its drawbacks such as availability of representative end users, high cost of testing and lack of true representation of a user's actual work environment. To counteract these issues various alternative and less expensive usability evaluation methods (UEMs) have been developed over the past decade. One such UEM is the Remote Usability Evaluation method. Remote evaluation is a relatively new area and lacks empirical data to support the approach. The need for empirical support was addressed in this study. The overall purpose of this study was to determine the differences in the effectiveness of the two evaluation types, the remote evaluation approach (SREM) and the traditional evaluation approach, in collecting usability data. This study also compared the effectiveness between the two methods based on user type, usability novice users and usability experienced users. Finally, the hypothesis that users, in general, will prefer the remote evaluation approach of reporting to the traditional in-lab evaluation approach was also tested. Results indicated that, in general, the synchronous remote approach is at least as effective as the traditional in lab usability evaluation approach in collecting usability data across all user types. However, when user type was taken into consideration, it was found that there was a significant difference in the high severity negative critical incident data collected between the two approaches for the novice user group. The traditional approach collected significantly more high severity negative critical incident data than the remote approach. Additionally, results indicate that users tend to be more willing to participate in the same approach as the one they participated previously. Recommendations for usability evaluators for conducting the SREM approach and areas for future research are identified in the study. / Master of Science

Augmented reality (AR) is an emerging technology with immense potential for enhancing human-to-human interaction tasks, particularly in high-risk environments such as mass casualty incident (MCI) tri-age. However, developing practical and effective AR tools for this purpose necessitates a meticulous user-centered design (UCD) process, thoughtfully crafted and validated through iterative testing with first responders in increasingly contextually relevant simulations. In academic circles, the perceived complexity and time requirements of such a process might discourage its adoption within the constraints of traditional publishing cycles. This is likely due, in part, to a lack of representative applied UCD examples. This work addresses this challenge by presenting a scholarly UCD framework tailored specifically for MCI triage, which progresses seamlessly from controlled, context-free laboratory settings to virtual patient simulations and finally to realistic patient (actor) scenarios. Moreover, MCIs and triage are under-served areas, likely due to their high intensity and risk. This means developers need to 'get it right' as quickly as possible. UCD and evaluation alone are not an efficient means to developing these complex and dangerous work domains. Thus, this research also delves into a cognitive work analysis, offering a comprehensive breakdown of the MCI triage domain and how those findings inform future AR sup-ports. This analysis serves to fortify the foundation for future UCD endeavors in this critical space. Finally, it is imperative to recognize that MCI triage fundamentally involves human-to-human interaction supported by AR technology. Therefore, UCD efforts must encompass a diverse array of study stimuli and participants to ensure that the technology functions as intended across all demographic groups. It is established that racial bias exists in emergency room triage, creating worse outcomes for patients of color. Consequently, this study also investigates the potential impact of racial biases on MCI triage efficacy. This entire body of work has implications for UCD evaluation methodology, the development of future AR support tools, and the potential to catch racially biased negative performance before responders ever hit the field. / Doctor of Philosophy / Augmented reality (AR) is uniquely situated to make work within high-risk work environments, like mass casualty incident (MCI) response, safer and more effective. This is because AR augments the user's reali-ty with context-relevant information, like by providing a temperature gauge for firefighters that is always in their visual field. Development of such AR tools for a sensitive arena like MCIs requires several rigor-ous steps before those tools can be deployed in the field. It is crucial to engage in a user-centered design (UCD) process in partnership with actual emergency responders so they can help us understand what help they need. We outline that UCD process in Chapter 2. Once we understand what responders say they need help with, we then need to evaluate those pinch points in the broader context of their work. This means that we evaluate how their job process creates the situation where responders need the kind of help they are asking for. Understanding this helps us create solutions that address the responder's needs while we minimize any new problems created with implementing a new tool into the job. What we learned from examining the work domain is described in Chapter 3. Once we have this firm foundational understanding of responder needs and work and we have designed an AR support tool, we need to evaluate that tool for effectiveness. It is too dangerous to put the AR tool straight into the field, so Chapter 4 explores how we can create simulations of an MCI scenario to study our AR support tool. Finally, after evaluating our AR tool within the scenarios and the scenarios themselves, we evaluate (in Chapter 5) other facets of the job that may be impacting MCI response. In our case, we explore how racial bias may be impacting patient care. It is important to study bias as it has implications for future MCI training and AR tool development. Perhaps future work can explore an AR tool that offsets bias-based performance, or a training that helps catch bias before responders ever get to the real field.

Yes / This paper reports on a regionally based UK study uncovering what has worked well in learning from adverse incidents in hospitals. The purpose of this paper is to review the incident investigation methodology used in identifying strengths or weaknesses and explore the use of a database as a tool to embed learning. Documentary examination was conducted of all adverse incidents reported between 1 June 2011 and 30 June 2012 by three UK National Health Service hospitals. One root cause analysis report per adverse incident for each individual hospital was sent to an advisory group for a review. Using terms of reference supplied, the advisory group feedback was analysed using an inductive thematic approach. The emergent themes led to the generation of questions which informed seven in-depth semi-structured interviews. “Time” and “work pressures” were identified as barriers to using adverse incident investigations as tools for quality enhancement. Methodologically, a weakness in approach was that no criteria influenced the techniques which were used in investigating adverse incidents. Regarding the sharing of learning, the use of a database as a tool to embed learning across the region was not supported. Softer intelligence from adverse incident investigations could be usefully shared between hospitals through a regional forum. The use of a database as a tool to facilitate the sharing of learning from adverse incidents across the health economy is not supported.

The aim of the thesis is to describe and analyse how a group of women experience that their every-day lives are affected during and after primary breast cancer treatment. The thesis is a consecutive, longitudinal study that takes an explorative qualitative approach. Seventy-one women younger than 60 years of age with primary breast cancer were consecutively included in the study. The women were interviewed four or five times over a period of 4 to 6 years from end of radiotherapy. The analyses of the interviews were inspired by grounded theory and narrative analysis.  The thesis encompasses four papers. Paper I focused on the women’s contact with health care. The results of this study indicate that it is crucial for patients in a vulnerable situation to be admitted into a supportive system – ‘admitted into a helping plan’ – that, more or less explicitly, displays a well-thought-out plan of care. This is a process built on individual relationships with members of the health-care staff, but it ends up in a relationship to health care as a helping system, a ‘safe haven’ to attach to. Study II explored the women’s ideas about what motivated and discouraged their return to work. The results illustrate that the meaning of work fluctuates over time and that the processes of returning to work are conditioned by the patients’ individual life situations. Returning to work was regarded as an important part of the healing process because of how it generated and structured the women’s everyday lives. Returning to work meant demonstrating well-being and normalcy after breast cancer. Study III examined how life was lived and valued during and after treatment for breast cancer compared to pre-cancer life. The analysis showed that being afflicted with breast cancer was evaluated from a context of the women’s former everyday lives and stressed that how the women experienced breast cancer was a matter of personal circumstances. Study IV focused on how the women experienced and dealt with their altered bodies. The results showed that the women followed three different body-mind trajectories that depended to a significant extent on the severity of side effects and bodily alterations that resulted from their treatments. Being afflicted by breast cancer implies vulnerability and losses, but it can also involve benefits and provide new perspectives on life. How the overall breast cancer experience is valued seems to be very much a matter of circumstances in everyday life. This thesis highlights circumstances that focus in particular on contacts with health care, the body, the work situation, and the family situation.

La réussite du marketing relationnel dépend des préférences individuelles des clients, ceux-ci n'étant pas tous également réceptifs aux approches relationnelles. Il apparaît, à ce titre, nécessaire d'approfondir la connaissance des bénéfices relationnels attendus par les clients. Dans un design mixte séquentiel, des entretiens non-directifs menés auprès de clients en gestion de patrimoine, puis auprès de clients de banques de réseau, montrent et confirment l'existence de trois profils relationnels distincts : transactionnel, relationnel psychologique et relationnel socio-valorisable. Une matrice combinant l'attitude à l'argent et le stéréotype du banquier révèle des profils hybrides souhaitables vs indésirables. L'étude quantitative crée une échelle de mesure du stéréotype du banquier, enrichit l’échelle de l’attitude à l’argent de la dimension tabou, et aménage une échelle des bénéfices relationnels attendus. Le test d'hypothèses dans un modèle d'équations structurelles montre le rôle du stéréotype du banquier, de l'attitude à l'argent du client, de ses valeurs culturelles et des incidents critiques, dans l'explication des bénéfices relationnels attendu. / The success of relationship marketing depends on individual preferences, knowing that clients are not all equally receptive to relational approaches. It appears necessary for this purpose to improve knowledge about client’s expected relational benefits. Within a sequential mixed design, non-directive interviews conducted with wealth management clients, then with retail bank clients, show and confirm the existence of three distinct types of relational profiles : transactional, psychological relational and socio-valuable relational. A matrix combining the money attitude and the banker stereotype reveals desirable vs undesirable hybrid profiles. The quantitative study creates a scale to measure the banker stereotype, enriches the money attitude scale with the taboo dimension, and produces a scale for the expected relational benefits. The test of hypotheses in a structural equations model shows the role of the banker stereotype, the money attitude, the cultural values and critical incidents, in the formation of expected relational benefits

This thesis is based on four studies that explore accessibility for older adults during whole trips by public transport. The overall goal was to gain knowledge of the interrelationships among key variables and to develop a conceptual model of the overall accessibility of public transport. More specifically, the research goals were: (a) to explore links among the key variables postulated to be involved in overall accessibility and to explore the links between these variables and railway accessibility; (b) to gain a deeper understanding of links between critical incidents in traveling and travel behavior decisions; and (c) to develop a conceptual model of overall accessibility. The key variables contributing to overall accessibility are functional ability (depending partly on the person’s functional limitation or disease), travel behavior, and barriers encountered during whole-trip traveling involving train. Respondents with more than one functional limitation or disease reported lower functional ability than did those with only one such limitation and respondents with low functional ability were less frequent travelers than were those with high functional ability. Frequent travelers reported railway accessibility to be better than did those who traveled less frequently. The main barriers were ticket cost and poor punctuality, but respondents with the lowest functional ability attributed the barriers encountered to their own health. The critical incidents most frequently reported were found in the categories “physical environment onboard vehicles” and “physical environment at stations or stops”, as well as in the “pricing and planning during ticketing” phase of the trip. Five themes of reactions to critical incidents were identified that had resulted in behavior change: firm restrictions, unpredictability, unfair treatment, complicated trips, and earlier adverse experiences. A conceptual model of overall accessibility was developed, grounded in the empirical research results. This model is summarized in the following propositions: Overall accessibility is a reciprocal relationship among the barriers/facilitators encountered, functional ability, and travel behavior. Accessibility emerges in the person–environment interaction. To understand accessibility, past experiences and future expectations should both be considered, because both will guide travel decisions. / Measurements enable future train travelling for everybody

A presente dissertação tem por objetivo a proposição de mecanismos de compensação, pela via judicial, das iniquidades provocadas à saúde dos presos em regime fechado de reclusão, tendo em vista que os presídios brasileiros são, hoje, ambientes potencialmente endêmicos à saúde humana. Considerando-se que o acesso aos serviços de saúde nas prisões é modulado por julgamentos morais entre agentes penitenciários e os detentos, e que o sistema mantém e produz excessos e desvios durante a execução penal, serão objeto primordial desse estudo os incidentes processuais do art. 185 da Lei de Execução Penal, aos quais se delineará hipóteses de aplicação com vistas a individualizar a pena nos casos de adoecimento do recluso. Para tanto, a argumentação se construirá no sentido de que a manutenção de presos em situação de agravo ou enfermos, por negligência do Estado, é uma conduta que mantém pontos de aproximação com a tortura institucional, inadmissível no contexto do Estado Democrático de Direito. O trabalho será eminentemente teórico e propositivo, e articulará temas de saúde pública, direito da execução penal e política criminal. / The purpose of this dissertation is to propose mechanisms of compensation, through the judicial way, of the iniquities provoked to the health of prisoners in closed regime of incarceration, bearing in mind that Brazilian prisons are now potentially endemic ambience for human health. Whereas access to health services in prisons is modulated by moral judgments between prison staff and prisoners, and that the system maintains and produces excesses and deviations during the criminal execution, the primary object of this study will be the procedural incidents of article 185 of the Criminal Execution Law which will outline hypotheses of application with a view to individualizing the sentence in cases of illness of the prisoner. Therefore, an argument will be built in the sense of maintaining prisoners in situations of injury or illness, by negligence of the State, it is a conduct that maintains points of approximation with the institutional torture, inadmissible in the context of the Democratic State of Law. The work will be eminently theoretical and propositive, and articulate issues of public health, criminal enforcement law and criminal politics.