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.

Le retour d'expérience (REX), sous la forme d'analyses d'accident le plus souvent, constitue un instrument privilégié de management de la sécurité dans les organisations industrielles à hauts risques. Cette recherche s'inscrit dans le domaine de la sécurité dans les tunnels routiers et vise à proposer une approche intégrée du REX, qui repose sur le travail quotidien de gestion de la sécurité par les opérateurs en s'appuyant sur les espaces collectifs de construction de l'expérience. La thèse défendue est que la sécurité dans les environnements dynamiques tels que les tunnels routiers repose sur la capacité des collectifs de travail transverses à faire face aux imprévus, les perturbations quotidiennes comme les évènements. Cette capacité se construit notamment à travers les discussions entre opérateurs et avec leurs managers sur les difficultés de leur travail. Les dispositifs de REX doivent favoriser l'existence de débats sur l'activité pour améliorer la gestion de la sécurité et favoriser ainsi le développement de l'individu et de l'organisation. Cependant cela implique des conditions d'organisation pour que le débat soit possible et pérenne.Une intervention-recherche visant la conception d'un dispositif de REX fondé sur l'activité individuelle et collective a été réalisée chez un exploitant de tunnels routiers pour éclairer cette problématique. Les analyses menées en collaboration avec les opérateurs de l'exploitation avaient pour objectifs d'aider les opérateurs à mettre en relation la manière dont ils gèrent la sécurité sur le terrain avec la manière dont le REX traite les évènements. L'analyse du REX existant montre dans un premier temps qu'il est centré sur les évènements de trafic majeurs, faisant l'objet de procédures et de règles formelles, alors que les incidents critiques pour les opérateurs sont majoritairement des incidents d'exploitation, peu cadrés. Dans un second temps, l'analyse de l'activité montre que les opérateurs développent de façon informelle des instances d'échange collectif pour anticiper les aléas, s'organiser et analyser les évènements. Une démarche de simulation organisationnelle avec les opérateurs, les managers et les partenaires de la recherche a été engagée pour transformer le dispositif de REX. Elle débouche sur un REX élargi en termes de définition des évènements et d'acteurs impliqués. Le nouveau dispositif s'appuie sur les processus-métiers existants, tout en développant les instances collectives d'analyse inter-métiers et inter-organisations. Il structure les pratiques informelles d'organisation et de partage d'expérience des opérateurs. Des espaces de discussion inter-métiers sur les pratiques réelles ont pu s'élaborer à partir de simulations d'évènement, animés par des managers de proximité. L'expérimentation de cette méthodologie montre que ces espaces favorisent la confrontation des représentations, des pratiques et la transmission des connaissances. Ils permettent aussi l'élaboration de règles opérationnelles transverses et font émerger les besoins de règles formelles à relayer aux managers. Ils sont constructifs car ils participent au développement de l'organisation formelle autant que de l'activité des opérateurs. Cette méthodologie a favorisé la construction de l'expérience à partir de l'analyse des évènements.L'intervention-recherche a permis de revenir sur les classifications officielles des évènements dans les tunnels routiers. Les conditions et modalités de mise en place d'un REX intégré sont définies et discutées, ainsi que celles des espaces de discussion par simulation. L'ingénierie de l'intervention ergonomique de conception organisationnelle et la place de l'intervenant sont aussi revisitées à l'aune de nos résultats. / Operating experience feedback, mainly through accident analysis is a method of choice for safety management in high risk organizations. The present research takes place in the field of road tunnel safety, proposing an integrated approach of experience feedback from the daily management of safety by tunnel monitoring staff through collective spaces for discussion and experience building.Our hypothesis is that safety in such dynamic environments as road tunnels depends on the capacity of operating teams to face the unexpected events, disturbances and accidents. This capacity is built through discussions between operating staff and with the management about the difficulties encountered during work. The return on operating experience should allow the debate on work activity in order to reach a better safety management, foster individual development and a better organization. However, there are organizational conditions for the debate to be possible and sustainable.A research and intervention protocol was set up with a road tunnel operator to test and improve a scheme for the return on operating experience based on individual and collective activity. Analyses were conducted to help operational staff link the way events are treated in day to day security management with the processing in the operational experience feedback scheme. An analysis of the current scheme showed that it is focussed on major traffic events, comprising of a set of procedures and formal rules, while the operational events, felt as critical by operators do not have a framework for discussion. Further, work activity analysis shows that operational staff develops informal spaces of collective exchanges to organize work, anticipate hazards and analyse events.Organizational simulations including operating staff, managers and the research partners were set up to transform the feedback scheme. The simulation led to an enlarged framework for feedback, defining the events to be analysed and participants to be included. The new scheme roots in the existing professional processes, develops inter-professional as well as inter-organization discussion spaces. The new scheme facilitates the sharing of experience among operating staff and structures the informal organizational practices we observed.Inter-professional discussion spaces, conducted by the team managers, were set up based on the analysis of simulated events. These structured discussion spaces proved to be effective in the confrontation of work practices, events and roles representations as well as conducive for knowledge transmission. The discussion space allows setting transverse operational rules and highlights the need for formal rules to be set by the management. The inter-professional discussion spaces are operant in improving the formal organisation as well as developing the activity of operational staff. This methodology favoured the building of experience from event analysis.This research-intervention was an opportunity to review the official classification of road tunnel events. The conditions for an integrated operating experience feedback scheme are set and discussed, as well as the implementation of simulation-based discussion spaces.From our results, we re-consider the design of interventions in organizational design, as well as the role of the intervening ergonomist.

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.