On the off chance that you think quality and wellbeing are the same...think once more

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Karen Cardiff, School of Population and Public Health, University of BC Samuel B Sheps, School of Population and Public Health, University of BC Jim Nyce, Department of Anthropology, College of Sciences and Humanities, Ball State University, Muncie Indiana Sidney Dekker, Lund School of Aviation, Lund University, Lund, Sweden June 10, 2010 System Safety Society Canada Chapter—Spring Symposium Ottawa, Ontario If you think quality and wellbeing are the same...think once more

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The discoveries displayed today depend on the postulation work for fruition of a MSc in Human Factors and System Safety with the Department of Aviation, Lund University of British Columbia School of Population and Public Health

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Also educated by work that started 10 years prior Canadian Adverse Events Project (Canadian Institutes of Health Research, 2000-2003) Management and Regulation of Safety in Risk Critical Sectors (Health Canada, 2004-2007) Creating High Reliability Organizations in the Canadian Health Care System (Canadian Patient Safety Institute, 2007-2008) Current work co-financed by the Canadian Health Services Research Foundation and the Canadian Patient Safety Institute—a four year multi-accomplice limit building venture that is centered around building limit inside intense care clinics to do basic occurrence examination (Sheps and Cardiff, 2009-2013) Interaction with global assessment pioneers and specialists in framework security on the emerging thoughts of flexibility and security (Sidney Dekker, Eric Hollnagel, René Amalberti, Richard Cook, and so on) University of British Columbia School of Population and Public Health

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Outline of presentation Background Why is the subject essential Theories and models of why things turn out badly Findings from the theory work University of British Columbia School of Population and Public Health

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Background When patients endow themselves to our care, we make two understood, yet scratch proficient and authoritative guarantees: " we guarantee to do everything conceivable to help patients—to give great (potentially fabulous) care; and, we guarantee not to hurt them " ( Reinertsen & Clancy, 2006) However, there are numerous cases where individuals don't get the care that they require (McGlynn et al 2003) or are incidentally hurt through the procedure of care (Kohn et al, 1999; Vincent et al, 2001; David et al 2002; Norton et al, 2004; Leape et al, 2005). College of British Columbia School of Population and Public Health

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While being worried with quality for a long time, medicinal services did not, when all is said in done, contemplate quiet wellbeing until the greatness of the issue turned out to be clear and could never again be overlooked. Presently, after over 10 years of action that has measured, followed, and in numerous occasions explored unfriendly occasions in intense care, nobody questions that upgrading persistent wellbeing (i.e. diminishing mischief ) is a vital and vital objective Although there keeps on being across the board purchase in that the medicinal services framework must find a way to lessen persistent damage, the battle in how to accomplish this, and make it practical, remains. Indeed, even as the quantity of exercises to enhance persistent security and quality increments, alongside a the scope of devices accessible to help with the procedure the social insurance framework has not yet accomplished the status of being a high unwavering quality or strong industry. College of British Columbia School of Population and Public Health

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While developing hypothetical and connected work recognize that quality and wellbeing are particular ideas, in social insurance the dominant part of exercises, to date, have concentrated on exercises intended to enhance adherence to acknowledged norms of care, for example, hand-washing, fitting utilization of anti-infection agents (i.e. telling individuals what they definitely know they ought to do), and are more adjusted to the great quality model than wellbeing – security by imperative set apart by obstructions, directions, strategies, preparing and institutionalization. The present endeavors are to a great extent in light of "reductionistic" imagining that endeavors to "investigate and settle things". Despite the fact that a number of these endeavors have been met with achievement, they have to a great extent overlooked issues identified with creating security in mind boggling, dynamic settings, for example, planning forefront staff to adapt to the unpredictability that they confront once a day and supporting them to wind up more experienced with reckoning what may turn out badly (imperative creative energy) and knowing when and how to adjust their execution under states of vulnerability. College of British Columbia School of Population and Public Health

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Understanding antagonistic occasions in medicinal services 'A model regularly utilized as a part of social insurance is that mischances are thought to happen when singular segments or procedures neglect to meet criteria… .this model of hazard and security expands on the suspicion that wellbeing, once settled, can be kept up by keeping the execution of a framework's parts (human and specialized) inside specific limits (e.g. individuals ought not damage standards and systems) ' Sidney Dekker, Past the edge of tumult . 2006 University of British Columbia School of Population and Public Health

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Why does the exemplary quality model contort endeavors to accomplish security? The great quality model was produced to guarantee that the framework meets pre-indicated criteria. Quality is seen as the attributes of an administration or item that must be available to address issues or desires –, for example, high expert principles, viable utilization of assets and high patient fulfillment The objective of value affirmation movement is to hold execution fluctuation under control –organizations create strategies, tenets and conventions to keep execution inside a specific data transmission. College of British Columbia School of Population and Public Health

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In straight generation frameworks (e.g. Toyota, McDonalds) quality may have security as an added substance result – this is on account of: the frameworks can be deteriorated into important components the disappointment likelihood of individual parts can be portrayed and broke down exclusively the request or succession of occasions is foreordained and altered when mixes of occasions happen they can be depicted as non associating the impact of setting is constrained or quantifiable (Dekker, 2007) However, since the way toward "delivering" human services is neither direct nor settled, the great quality model is not sufficient. College of British Columbia School of Population and Public Health

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Complex frameworks 'in complex frameworks, (for example, human services), eccentrics and oddity are ever present, and a few things will stay mysterious… .new reasonable structures that fuse a dynamic, new, imaginative and natural perspective of the world must supplant conventional "decrease and resolve" ways to deal with clinical care and administration association' (Plsek, 2001) University of British Columbia School of Population and Public Health

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Examples of multifaceted nature in social insurance Demand much of the time pushes execution objectives; Rapid presentation of new, complex innovation; Many discontinuities and moves in care (e.g. numerous look after a similar patient and regularly in various settings – crisis division to working space to surgical ward—every unit oversaw freely); Strong independent and semi-self-governing proficient societies with accompanying force battles; Often fast turnover in staff; Continual flood of new patients, each with their own particular inborn organic changeability and in numerous examples dialect and social contrasts . College of British Columbia School of Population and Public Health

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The key test of making security in complex non straight frameworks is that the information base is characteristically and for all time inadequate. In social insurance work circumstances are constantly underspecified (i.e. the states of work once in a while coordinate what has been indicated or endorsed), and with this comes an erratic segment , and along these lines adjustment is regularly essential (Hollnagel et al, 2006; Grote, 2006) Performance fluctuation is both typical and vital in complex non direct frameworks (Dekker, 2007; Hollnagel, 2008) University of British Columbia School of Population and Public Health

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Performance inconstancy, adjustment & security IF protecting things measures up to keeping execution inside a specific transmission capacity, why do mind boggling, dynamic associations esteem experience or status? It is on account of experience brings a more extensive data transfer capacity – individuals at the sharp end of care can judge whether that which they utilized before will act as a part of the present circumstance. There is dependably a strain around when and how to adjust principles and conventions to the arrangement of conditions one ends up in, yet the accomplished individual will probably know when and how. Complex frameworks are for the most part very much shielded from vulnerabilities with "hindrances", however security is made through practice, i.e. experts perceive neighborhood pitfalls and hinder them, and this frequently includes adjustment. College of British Columbia School of Population and Public Health

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Theories and models of why things turn out badly: Linear perspectives (Dekker, 2007; Hollnagel , 2008) Assumption and result: Accidents are the regular result of a progression of occasions or conditions which happen in a particular and unmistakable way (e.g. Domino Model, Heinrich, 1930) ��  a ccidents are anticipated by finding and wiping out conceivable causes – part disappointments, for example, human specialized and hierarchical . Suspicion and outcome: More as of late, mishaps have been seen to come about because of a mix of dynamic disappointments (risky acts) and dormant conditions (dangers) ��  mischances are counteracted by fortifying hindrances and protections (e.g. Swiss Cheese Model, Reason, 1990) and wellbeing is e

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