Presentation
Systemic Contributors and Adaptations Diagramming: Implementation in a Proactive Safety and Performance Monitoring Program in Central Sterile Processing
DescriptionFor the past two years, we have partnered with the Central Sterile Supply (CSS) department at a large midwestern hospital system, including four CSS sites and four Operating Room (OR) sites, to conduct a system-wide analysis of pressures, goal conflicts, and adaptations that contribute to CSS work. Systemic Contributors and Adaptations Diagramming (SCAD) (Jefferies et al., 2022) was developed as a cognitive interviewing technique for proactive system safety and performance monitoring that can be deployed prospectively – that is, not in response to an accident or incident – to understand the dynamic and interdependent forces continuously active in the system that contribute to the way everyday work is performed. Understanding these forces, which include systemic pressures and goals and how they come into conflict and are locally resolved through adaptations, helps to generate foresight about the changing shape of risk in the organization (Woods, 2005; Provan et al., 2018). The aim of this system-wide analysis is to inform the development and implementation of a sustainable proactive safety and performance monitoring program that integrates SCAD and data analytics.
This paper describes findings from our first (broad) SCAD analysis of CSS and preliminary findings from our second (focused) SCAD analysis of CSS and the OR. These findings are of subtle, nearly invisible systems dynamics that quietly but strongly influence sterile surgical and perioperative work, including but not limited to: balancing efforts to standardize work with efforts to support frontline adaptations to standardized work; how teamwork and patient safety are usually mutually supportive, and how sometimes teamwork is deprioritized in favor of patient safety; an empathy-accountability double-bind described by many CSS and OR staff who recognize that their counterparts are doing the best they can under the circumstances, and yet are still falling short of expectations; how, in the face of multiple competing pressures and obvious gaps that are frustrating and demoralizing, the OR and CSS staff resist the urge to pull back from their work, instead actively working to fill systems gaps and ensure sustained operations.
We also identify barriers and facilitators to the implementation of the SCAD component of this proactive safety and performance monitoring program that we anticipated based on our SCAD findings, including nonhomogeneous ideological and mental model alignment and misalignment, how monitoring the variety of adaptations actively and continuously present in the system is masked by the law of fluency (Woods, 2006), and how the rapid tempo of everyday work and the frequent sudden reprioritization of frontline tasks challenges everyone’s ability to anticipate how work will be done, which itself challenges the pragmatics of enacting the larger proactive safety and performance monitoring program.
Finally, we will describe how our SCAD findings have informed our strategies to mitigate the barriers and facilitators we have encountered thus far through dynamic program redesign and cultivating interdisciplinary relationships among researchers and practitioners.
References
Jefferies, C. M., Balkin, E. A., Groom, L., & Rayo, M. F. (2022). Developing Systemic Contributors and Adaptations Diagramming (SCAD): Systemic insights, multiple pragmatic implementations. Proceedings of the 66th Annual International Meeting of the Human Factors and Ergonomics Society, 66, 75–79.
Provan, D. J., Woods, D. D., Dekker, S. W. A., & Rae, A. J. (2020). Safety II professionals: How resilience engineering can transform safety practice. Reliability Engineering & System Safety, 195. https://doi.org/10.1016/j.ress.2019.106740
Woods, D. D. (2005). Creating Foresight: Lessons for Enhancing Resilience from Columbia. In W. H. Starbuck & M. Farjoun (Eds.), Organization at the limit: Lessons from the Columbia disaster (pp. 289–308). Blackwell.
Woods, D. D. (2006). Laws that Govern Joint Cognitive Systems at Work (JCS). The Ohio State University.
This paper describes findings from our first (broad) SCAD analysis of CSS and preliminary findings from our second (focused) SCAD analysis of CSS and the OR. These findings are of subtle, nearly invisible systems dynamics that quietly but strongly influence sterile surgical and perioperative work, including but not limited to: balancing efforts to standardize work with efforts to support frontline adaptations to standardized work; how teamwork and patient safety are usually mutually supportive, and how sometimes teamwork is deprioritized in favor of patient safety; an empathy-accountability double-bind described by many CSS and OR staff who recognize that their counterparts are doing the best they can under the circumstances, and yet are still falling short of expectations; how, in the face of multiple competing pressures and obvious gaps that are frustrating and demoralizing, the OR and CSS staff resist the urge to pull back from their work, instead actively working to fill systems gaps and ensure sustained operations.
We also identify barriers and facilitators to the implementation of the SCAD component of this proactive safety and performance monitoring program that we anticipated based on our SCAD findings, including nonhomogeneous ideological and mental model alignment and misalignment, how monitoring the variety of adaptations actively and continuously present in the system is masked by the law of fluency (Woods, 2006), and how the rapid tempo of everyday work and the frequent sudden reprioritization of frontline tasks challenges everyone’s ability to anticipate how work will be done, which itself challenges the pragmatics of enacting the larger proactive safety and performance monitoring program.
Finally, we will describe how our SCAD findings have informed our strategies to mitigate the barriers and facilitators we have encountered thus far through dynamic program redesign and cultivating interdisciplinary relationships among researchers and practitioners.
References
Jefferies, C. M., Balkin, E. A., Groom, L., & Rayo, M. F. (2022). Developing Systemic Contributors and Adaptations Diagramming (SCAD): Systemic insights, multiple pragmatic implementations. Proceedings of the 66th Annual International Meeting of the Human Factors and Ergonomics Society, 66, 75–79.
Provan, D. J., Woods, D. D., Dekker, S. W. A., & Rae, A. J. (2020). Safety II professionals: How resilience engineering can transform safety practice. Reliability Engineering & System Safety, 195. https://doi.org/10.1016/j.ress.2019.106740
Woods, D. D. (2005). Creating Foresight: Lessons for Enhancing Resilience from Columbia. In W. H. Starbuck & M. Farjoun (Eds.), Organization at the limit: Lessons from the Columbia disaster (pp. 289–308). Blackwell.
Woods, D. D. (2006). Laws that Govern Joint Cognitive Systems at Work (JCS). The Ohio State University.
Event Type
Oral Presentations
TimeMonday, March 252:24pm - 2:42pm CDT
LocationSalon A-3
Patient Safety Research and Initiatives