TY - JOUR
T1 - Capturing challenges and trade-offs in healthcare work using the pressures diagram
T2 - An ethnographic study
AU - Sanford, Natalie
AU - Lavelle, Mary
AU - Markiewicz, Ola
AU - Reedy, Gabriel
AU - Rafferty, Anne Marie
AU - Darzi, Ara
AU - Anderson, Janet E.
N1 - Funding Information:
This study was supported by the NIHR Imperial Patient Safety Translational Research Centre [PSTRC-2016-004]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Infrastructure support for this research was also provided by the NIHR Imperial Biomedical Research Centre (BRC).
Funding Information:
This study was supported by the NIHR Imperial Patient Safety Translational Research Centre [PSTRC-2016-004]. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Infrastructure support for this research was also provided by the NIHR Imperial Biomedical Research Centre ( BRC ).
Publisher Copyright:
© 2022
PY - 2022/5
Y1 - 2022/5
N2 - Healthcare workers must balance competing priorities to deliver high-quality patient care. Rasmussen's Dynamic Safety Model proposed three factors that organisations must balance to maintain acceptable performance, but there has been little empirical exploration of these ideas, and little is known about the risk trade-offs workers make in practice. The aim of this study was to investigate the different pressures that healthcare workers experience, what risk trade-off decisions they make in response to pressures, and to analyse the implications for quality and safety. The study involved 88.5 h of ethnographic observations at a large, teaching hospital in central London. The analysis revealed five distinct categories of hospital pressures faced by healthcare workers: efficiency, organisational, workload, personal, and quality and safety pressures. Workers most often traded-off workload, personal, and quality and safety pressures to accommodate system-level priorities. The Pressures Diagram was developed to visualise risk trade-offs and prioritising decisions and to facilitate communication about these aspects of healthcare work.
AB - Healthcare workers must balance competing priorities to deliver high-quality patient care. Rasmussen's Dynamic Safety Model proposed three factors that organisations must balance to maintain acceptable performance, but there has been little empirical exploration of these ideas, and little is known about the risk trade-offs workers make in practice. The aim of this study was to investigate the different pressures that healthcare workers experience, what risk trade-off decisions they make in response to pressures, and to analyse the implications for quality and safety. The study involved 88.5 h of ethnographic observations at a large, teaching hospital in central London. The analysis revealed five distinct categories of hospital pressures faced by healthcare workers: efficiency, organisational, workload, personal, and quality and safety pressures. Workers most often traded-off workload, personal, and quality and safety pressures to accommodate system-level priorities. The Pressures Diagram was developed to visualise risk trade-offs and prioritising decisions and to facilitate communication about these aspects of healthcare work.
KW - Healthcare safety
KW - Human factors
KW - Resilient healthcare
UR - http://www.scopus.com/inward/record.url?scp=85123754596&partnerID=8YFLogxK
U2 - 10.1016/j.apergo.2022.103688
DO - 10.1016/j.apergo.2022.103688
M3 - Article
AN - SCOPUS:85123754596
SN - 0003-6870
VL - 101
JO - APPLIED ERGONOMICS
JF - APPLIED ERGONOMICS
M1 - 103688
ER -