The ageing population of Sweden is expected to increase throughout the future decades. Changing life-style trends and smaller families in the modern society has decreased the population’s access to informal care. This is expected to entail an increase in the services provided by specialized home care. This thesis studies the work performed by nurses within the department of specialized home care (ASIH) in Stockholm County. The nurses represent the majority of all professions active at ASIH in Stockholm County, which puts their work in particular interest for this thesis. The thesis focuses on the ways the nurses’ work procedures may influence continuity of care and patient safety. Continuity of care is an essential component in qualitative care and is characterized by well-executed coordination and minimization of broken patient appointments. A high level of continuity of care consequently entails a high level of patient safety. Descriptions of continuity of care at ASIH in Stockholm County can therefore provide indications on current care quality and areas of improvement. The thesis consists of two parts – a literature review containing international research on continuity within home care and an empirical study containing a retrospective analysis based on the Functional Resonance Analysis Method (FRAM). The empirical study creates an overview of work tasks related to nursing performed at three units of ASIH in Stockholm County. The interdependencies between work tasks are identified and important chain reactions are analyzed. The findings from this thesis indicate that extended training programs for nurses in the initial phase of employment is likely to decrease the number of disruptions in the nurses’ work. Furthermore, well-developed routines could facilitate work task procedures which would decrease the number of delays and disruptions in the nurses’ work. It was found that these findings together with information continuity between all parties involved represent significant factors for attaining continuity of care and patient safety at ASIH in Stockholm County. / Den äldre befolkningen i Sverige förväntas öka under de kommande årtiondena. Det moderna samhället har dessutom medfört förändrade livsstilar och allt mindre familjekonstellationer, vilket har resulterat i en minskad tillgång till anhörigvård. Detta förväntas medföra en ökad efterfrågan av tjänster som tillhandahålls av specialiserad hemsjukvård. Den specialiserade hemsjukvården ansvaras av Avancerad Sjukvård I Hemmet (ASIH) i Stockholms län. Sjuksköterskor utgör den största andelen anställda av de yrken som är verksamma vid ASIH. Denna rapport undersöker sjuksköterskornas arbetsflöden vid tre ASIH-enheter i Stockholms län. Rapporten fokuserar på att undersöka på vilka sätt sjuksköterskornas arbetsprocesser kan påverka vårdens kontinuitet och patientsäkerhet. Vårdkontinuitet är ett centralt begrepp i kvalitativ hemsjukvård och kännetecknas av välkoordinerad vård och lågt antal otillfredsställande patientbesök. God vårdkontinuitet förväntas medföra hög patientsäkerhet. Återgivningar av den nuvarande vårdkontinuiteten på ASIH i Stockholms län tros därför kunna skapa en uppfattning om den nuvarande vårdkvaliteten samt eventuella förbättringsområden. Denna rapport utgörs av två delar – en litteraturstudie som innehåller internationell forskning om vårdkontinuitet i hemsjukvård samt en empirisk studie som innehåller en retrospektiv analys baserad på Functional Resonance Analysis Method (FRAM). Den empiriska studien skapar en översikt över sjuksköterskors huvudsakliga arbetsuppgifter vid de tre undersökta ASIH-enheterna belägna i Stockholms län. Arbetsuppgifternas korrelationer samt ömsesidiga påverkan kartläggs och signifikanta kedjereaktioner analyseras. Resultaten i denna rapport påvisar att utökad undervisning för sjuksköterskor i anställningens inledande skede kan troligen minska antalet störningar i sjuksköterskornas dagliga arbete. Dessutom påvisar resultaten att fler tydliga rutiner skulle kunna underlätta sjuksköterskornas arbetsprocesser, vilket skulle kunna minska antal förseningar och störningar i deras dagliga arbete ytterligare. Dessa fynd i kombination med välfungerande kommunikationer mellan alla berörda parter utgör de huvudsakliga åtgärderna för att erhålla vårdkontinuitet och patientsäkerhet hos ASIH i Stockholms län.

The Vessel Traffic Service (VTS) is a complex system tasked with ensuring the safety of navigation within specified areas known as VTS areas. Earlier research in the domain has often focused on the decision support systems and other tools employed by the VTS operators to provide the vessels in the area with VTS services. Consequently, less effort has gone into looking at the system itself and the human factors aspects of the system. This study uses the Functional Resonance Analysis Method (FRAM) to create a functional model of the VTS. It looks at how a VTS works, what the different components are and how these components are related. The main purpose of the FRAM model is to serve as a basis for future application by identifying the functions that constitute the system, and to illuminate the potential variability therein. To demonstrate how it might be used, an instantiation of an observed scenario will be presented. A structural description of the VTS is also presented, which aims to serve as an introduction to the domain for readers who are previously unfamiliar with it. The functional model shows that a lot of the potential variability seems to lie in the functions that rely heavily on human interaction, which is to be expected, as human performance is highly variable. It also shows that the availability and reliability of relevant information is crucial in order to be able to provide the VTS services, and if the information for some reason is unavailable or insufficient it seems likely to cause variability.

Grades serve as one of the primary indicators of student learning, directing subsequent actions for students, instructors, and administrators, alike. Therefore, grade validity—that is, the extent to which grades communicate a meaningful and credible representation of what they purport to measure—is of utmost importance. However, a grade cannot be valid if one cannot trust that it will consistently and reliably result in the same value, regardless of who makes a measure or when they make it. Unfortunately, such reliability becomes increasingly challenging to achieve with larger class sizes, especially when utilizing multiple evaluators, as is often the case with mandatory introductory courses at large universities. Reliability suffers further when evaluating open-ended tasks, as are prevalent in authentic, high-quality engineering coursework.<div><br></div><div>This study explores grading reliability in the context of a large, multi-section engineering course. Recognizing the number of people involved and the plethora of activities that affect grading outcomes, the study adopts a systems approach to conduct a human reliability analysis using the Functional Resonance Analysis Method. Through this method, a collection of data sources, including course materials and observational interviews with undergraduate teaching assistant graders, are synthesized to produce a general model for how actions vary and affect subsequent actions within the system under study. Using a course assignment and student responses, the model shows how differences in contextual variables affect expected actions within the system. Next, the model is applied to each of the observational interviews with undergraduate teaching assistants to demonstrate how these actions occur in practice and to compare graders to one another and with expected behaviors. These results are further related to the agreement in system outcomes, or grades, assigned by each grader to guide analysis of how actions within the system affect its outcome.<br></div><div><br></div><div>The results of this study connect and elaborate upon previous models of grader cognition by analyzing the phenomenon in engineering, a previously unexplored context. The model presented can be easily generalized and adapted to smaller systems with fewer actors to understand sources of variability and potential threats to outcome reliability. The analysis of observed outcome instantiations guides a set of recommendations for minimizing grading variability.<br></div>