Emergency response team (ERT) member characteristics that contribute to High Reliability performance during patient care resuscitation events or other Critical Incident Management Situations are poorly understood. Findings from this study describe individual characteristics that experienced interprofessional ERT members perceive as contributing to High Reliability performance within the critical incident management context. This study supports the need for interprofessional research about emergency response teams’ High Reliability in hospital-based settings. ERT High Reliability, or “better than expected” team performance has been linked to overall patient care and safety. The purpose of this study was to identify and describe individual team member characteristics that contribute to High Reliability performance of ERT members and the overall emergency response team in a naturalistic setting during Critical Incident Management Situations. Using a qualitative descriptive design, data collection included participant observations, field notes, and interviews. Narrative data were audio-taped, transcribed and coded using Ethnograph v6©. Data content were analyzed thematically using inductive interpretive methods. Two major domains derived from the data were Self-Regulation and Whole-Team Regulation. The overarching theme, Orchestrating High Reliability at the Edge of Chaos, encompassed characteristics contributing to High Reliability performance of the ERT during Critical Incident Management Situations.

There are certain organizations that manage to handle risk in such a successful way that they almost stay error-free, in spite of the fact that they daily face the risks of accidents. These organizations are usually given the name High Reliability Organizations (HRO). While the most common example is that of a nuclear plant the variety of what organizations can fit into the category is extensive. The purpose of this study is to describe safety culture and theories about HRO and how these can be found in practise within an organization. This qualitative research uses influences of ethnography in its method. The ethnographical approach was picked due to the field of the study and the cultural context in which it is set. The results of the study identify a number of elements sorted into four themes. These themes are deemed compatible or non-compatible with relevant existing theories. While most of the results match, the issue of routine-based work is not coherent with leading theories of HRO. An effort in making an alternative explanation proposing a balance between routines and mindfulness is taken on the subject.

<p>There are certain organizations that manage to handle risk in such a successful way that they almost stay error-free, in spite of the fact that they daily face the risks of accidents. These organizations are usually given the name High Reliability Organizations (HRO). While the most common example is that of a nuclear plant the variety of what organizations can fit into the category is extensive.</p><p>The purpose of this study is to describe safety culture and theories about HRO and how these can be found in practise within an organization.</p><p>This qualitative research uses influences of ethnography in its method. The ethnographical approach was picked due to the field of the study and the cultural context in which it is set.</p><p>The results of the study identify a number of elements sorted into four themes. These themes are deemed compatible or non-compatible with relevant existing theories. While most of the results match, the issue of routine-based work is not coherent with leading theories of HRO. An effort in making an alternative explanation proposing a balance between routines and mindfulness is taken on the subject.</p>

Bakgrund: Uppsatsen tar upp problematiken kring att organisera arbetstid inom räddningstjänst. Grundförutsättningarna är att räddningstjänst är en High Reliability Organisation (HRO) och att det påverkar organisationen. I och med New Public Management (NPM) framfart och den ekonomiska situationen i världen har räddningstjänsten fått ett ökat krav på kostnadsbesparingar och resursutnyttjande. Då personalkostnader står för en stor del av räddningstjänstens kostnader kan förändringar av brandmännens arbetstid och skiftgång vara ett logiskt steg, något som skett i Greater Manchester Fire and Rescue Service (GMFRS). Syfte: Syftet med uppsatsen är ett ge ett teoretiskt bidrag till hur NPM influerade reformer påverkar en HRO. För att göra detta frågar vi oss vad de olika skiftformerna får för konsekvenser för de anställda och organisationen. Metod: Uppsatsen har en kvalitativ forskningsansats vid studerandet av fallorganisationen Greater Manchester Fire and Rescue Service och Storstockholms Brandförsvar. Data har samlats in främst genom intervjuer men vi har även använt oss av kompletterande observationer och dokumentsstudier. Den analysmetod vi valt är tematisering då denna underlättar vår analys genom att empirin bryts ner och kategoriseras. Resultat: Studiens resultat identifierar olika faktorer som påverkar organisationens medvetenhet samt arbetsmiljö. Det förs en diskussion huruvida dessa faktorer bidrar till en förstärkning eller en försvagning samt att mönster mellan påverkan på medvetenheten och arbetsmiljön undersöks.

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Each organization has its specifics that affect the way knowledge is created and transferred. The existing literature in the field of knowledge creation, studies contemporary organizations and currently does not consider special cases such as high reliability organizations. Therefore, the aim of this thesis is to complement the existing knowledge creation model by describing the knowledge creation process for high reliability organizations using the case study of the Lambohov Fire Station. A qualitative case study was conducted and carried out with the help of Lambohov Fire Station through non-participant observations and semi- structured interviews with one of the fire brigades. Our research has revealed that the learning processes in HROs differs from the existing theoretical framework. According to the literature, knowledge is created through conversion of tacit and explicit knowledge, while at the fire station the conversion involves tacit and implicit types of knowledge.

Research has shown that 400,000 people die every year due to preventable medical errors. Medical error reporting and safety is a responsibility of all members of a health care organization. Creating an environment that addresses and prevents potential or actual safety problems can help reduce the incidence of medical errors made by nurses in the workplace. The purpose of this quantitative research study was to determine if nurses' perceptions of safety problems and error-preventing procedures and systems affected their comfort in reporting safety problems and intent to leave. High-reliability theory was the theoretical foundation for this study. Data were obtained from 1,171 surveys completed by newly licensed registered nurses located in 51 different metropolitan statistical areas and 9 counties. SPSS Version 25 was used to conduct a secondary data analysis including descriptive statistics, bivariate analysis, and multiple logistic regression for each variable. Themes that emerged from the data analysis included the importance of education on safety protocols and improving nurse satisfaction and nurse retention. The findings of the study might contribute to social change by creating an increased awareness for nurse leaders, managers, and newly licensed registered nurses in ensuring that there is improved comfort of reporting and appropriate error-preventing procedures and system in the health care environment. Increased awareness will allow for action and improved protocols to enhance the overall safety and quality of care for nurses and their patients.

Hintergrund: Für eine sicherheitsorientierte Versorgung in der Zentralen Notaufnahme (ZNA) bedarf es einer Sicherheitskultur, die aufbauend auf einem transparenten Umgang mit Fehlern das Lernen fördert. Insbesondere in Hochzuverlässigkeitsorganisationen (HRO) wird das Lernen als Chance für die stetige Verbesserung der Sicherheit gesehen. Ein Einflussfaktor für eine sicherheitsorientierte Patientenversorgung ist das Individuum. Aufbauend auf den individuellen Kompetenzen können die Kompetenzen auf allen Ebenen weiterentwickelt werden, welches in einer Lernenden Organisation angestrebt wird. Die Gestaltung einer Sicherheitskultur in einer ZNA im Sinne der Hochzuverlässigkeit durch Kompetenzen von Individuen und Kompetenzentwicklungsmaßnahmen erfolgt durch die Verknüpfung von den Fachdisziplinen der Organisationstheorie und der Bildungswissenschaft. Methodik: Für die Identifikation von Kompetenzen und Kompetenzentwicklungsmaßnahmen wurde ein Multi-Methoden-Ansatz gewählt. Zunächst wurden mögliche Risikofelder in der ZNA durch eine Analyse von 230 Critical Incident Reporting System (CRIS)-Fällen aus der CIRSmedical Datenbank identifiziert. Daraufhin wurde ein Kompetenzkatalog: Patientensicherheit in der Zentralen Notaufnahme aufbauend auf dem Kompetenzkatalog Europäisches Curriculum für Notfallmedizin sowie 34 weiteren Quellen entwickelt. Neben dem Kompetenzkatalog wurde der Basiskompetenzkatalog: Patientensicherheit hochzuverlässig gestalten für die Identifikation von Kompetenzen zugrunde gelegt. Weitere Informationen hinsichtlich der Identifikation und Entwicklung von Kompetenzen wurden durch Interviews mit zehn Experten und sieben Führungskräfte eines Kooperationskrankenhauses generiert. Ergebnisse aus dem Multi-Methoden Ansatz: Die Sicherheitskultur wird durch die Führungskräfte, die Institutionalisierung von Risikomanagementinstrumenten und durch das Individuum gestaltet. Für Professionals in der ZNA bedarf es fachlicher, methodischer, personeller und hochzuverlässiger Kompetenzen, um interprofessionelle, interdisziplinäre und situationsadäquate Entscheidungen zu treffen. Zudem sind die situative Sensibilität und Resilienz erforderlich. Von den Interviewpartnern wurde der kontinuierliche Lernprozess als ein entscheidender Einflussfaktor für die Sicherheitskultur in einer ZNA im Sinne der Hochzuverlässigkeit bezeichnet. Die Kompetenzentwicklung kann neben Personalentwicklungsmaßnahmen auch durch Risikomanagementinstrumente erfolgen. Dennoch gibt es hinsichtlich der Kompetenzentwicklung von Professionals in ZNA auch Herausforderungen. Schlussfolgerung: Die Sicherheitskultur in einer ZNA im Sinne der Hochzuverlässigkeit kann durch ein Kompetenzset aus fachlichen, methodischen, personellen und hochzuverlässigen Kompetenzen sowie der kontinuierlichen Kompetenzentwicklung gestaltet werden. Da bisher ein differenziertes Grundverständnis für die Hochzuverlässigkeit in der ZNA vorliegt und lernfördernde Rahmenbedingungen zu schaffen sind, sollte die ZNA im Hinblick auf den Zusammenhang mit der Hochzuverlässigkeit als high reliability seeking organization (HR-S-O) bezeichnet werden.

Under början av 1990-talet infördes reformer som än idag påverkar svensk äldreomsorg. Dessa reformer föranledde till stora förändringar i den offentliga sektorn, där privatiseringen av offentliga tjänster är en del av resultatet. I nästan tre decennier har resultatet av dessa reformer varit väl omdiskuterade i både politiska sammanhang och samhället, där äldreomsorgen är en av de stora reformerna som diskuteras. Föreliggande studie jämför och analyserar tillförlitlig kvalitet på given vård i äldreomsorgen mellan den offentliga och privata sektorn eftersom den privata sektorn ibland har ett vinstintresse, vilket den offentliga sektorn saknar. Syftet med studien var att jämföra och analysera hur chefer uppfattar möjligheten att ge tillförlitlig kvalitet i verksamheten. Arbetet i den dagliga verksamheten utförs av chefer och medarbetare tillsammans, vilket föranledde att det i studien intervjuades åtta chefer på äldreboenden i Sverige, där fyra chefer från respektive offentlig eller privat given äldrevård utgjorde studiens empiriska material. Intervjufrågorna var konstruerade utifrån studiens analysmodell som bygger på karaktäristiska egenskaper för organisationer med hög tillförlitlighet. Föreliggande studie visar att cheferna i både den offentliga och privata sektorn uppfattar, utifrån de förutsättningar som finns i äldreomsorgen, möjlighet till tillförlitlig kvalitet. Dock visar resultatet av studien att det finns brister i den tillförlitliga kvaliteten. Studiens vetenskapliga bidrag visar på kvaliteten utifrån de förutsättningar som chefer har att ge en tillförlitlig kvalitet i äldreomsorgen. / During the start of the 1990´s reforms were introduced that to this day affect Swedish elderly care. These reforms brought forth large alterations in the public sector where in multiple, previously public services were privatized. In the following three decades have these reforms been regularly discussed in both political contexts and society, where the reforms of the elderly care have been prominent. This study compares and analyze reliable quality of administrated care of elderly between the public and private sectors, because of the private sector´s common profit orientation, which the public sector does not have. The purpose of this study was to compare and analyze how management perceive the opportunity to give reliable quality within the organization. Operational labor is performed by both management and coworkers together which resulted in eight managers within the Swedish elderly care being interviewed wherein four worked in the public sector and private, respectively. These interviews became the empirical basis for the study. The interview questions were constructed using the studies analytical model which is based on characteristic properties within organization with high reliability. The result of this study shows that managers in both the public and private sectors perceive the possibility of reliable quality based on the conditions that exist in elderly care. However, the results of the study show that there are shortcomings in the reliable quality. The study´s scientific contribution indicates the quality based on the conditions that managers have to provide a reliable quality in elderly care.

Deux thématiques importantes des technologies de la santé: la pratique médicale fondée sur des preuves probantes et l’évaluation des interventions en médecine sont fondées sur une approche positiviste et une conception mécaniste des organisations en santé. Dans ce mémoire, nous soulevons l’hypothèse selon laquelle les théories de la complexité et la systémique permettent une conceptualisation différente de ces deux aspects de la gouvernance clinique d’une unité de Soins Intensifs Chirurgicaux (SIC), qui est considérée comme un système adaptatif dynamique non linéaire qui nécessite une approche systémique de la cognition. L’étude de cas d’une unité de SIC, permet de démontrer par de nombreux exemples et des analyses de micro-situations, toutes les caractéristiques de la complexité des patients critiques et instables et de la structure organisationnelle des SIC. Après une critique épistémologique de l’Evidence-Based Medicine nous proposons une pratique fondée sur des raisonnements cliniques alliant l’abduction, l’herméneutique et la systémique aux SIC. En nous inspirant des travaux de Karl Weick, nous suggérons aussi de repenser l’évaluation des modes d’interventions cliniques en s’inspirant de la notion d’organisation de haute fiabilité pour mettre en place les conditions nécessaires à l’amélioration des pratiques aux SIC. / In Health Technology Assessment and Management, Evidence-Based Medicine and many tools available for clinical assessment reflect a positivistic and mechanistic approach to Health Care Organizations and scientific knowledge. We argue that the Complexity Theories and the Systemic decision-making process give a different insight on those two aspects of Clinical Governance in a Surgical Intensive Care Unit (SICU). In a case-study, we describe the nature of critically ill and unstable patients and the organizational structure of a SICU in a university based hospital. We demonstrate all the characteristics of complexity in that setting, through the use of many examples and micro-situational analysis. After an epistemological critical appraisal of EBM, we suggest that if a SICU is conceptualized as a dynamic non-linear adaptative system, then clinical knowledge and scientific thought processes must include hermeneutical, systemic and abductive types of reasoning. Finally, we draw upon Karl Weick’s work and suggest that a SICU must be considered as a High Reliability Organization in order to aim for improving patient care and create better conditions for quality and performance in this complex environment.