Traditions of research into interruptions in healthcare: A conceptual review

Background Researchers from diverse theoretical backgrounds have studied workplace interruptions in healthcare, leading to a complex and conflicting body of literature. Understanding pre-existing viewpoints may advance the field more effectively than attempts to remove bias from investigations. Objective To identify research traditions that have motivated and guided interruptions research, and to note research questions posed, gaps in approach, and possible avenues for future research. Methods A critical review was conducted of research on interruptions in healthcare. Two researchers identified core research communities based on the community’s motivations, philosophical outlook, and methods. Among the characteristics used to categorise papers into research communities were the predominant motivation for studying interruptions, the research questions posed, and key contributions to the body of knowledge on interruptions in healthcare. In cases where a paper approached an equal number of characteristics from two traditions, it was placed in a blended research community. Results A total of 141 papers were identified and categorised; all papers identified were published from 1994 onwards. Four principal research communities emerged: epidemiology, quality improvement, cognitive systems engineering (CSE), and applied cognitive psychology. Blends and areas of mutual influence between the research communities were identified that combine the benefits of individual traditions, but there was a notable lack of blends incorporating quality improvement initiatives. The question most commonly posed by researchers across multiple communities was: what is the impact of interruptions? Impact was measured as a function of task time or risk in the epidemiology tradition, situation awareness in the CSE tradition, or resumption lag (time to resume an interrupted task) in the applied cognitive psychology tradition. No single question about interruptions in healthcare was shared by all four of the core communities. Conclusions Much research on workplace interruptions in healthcare can be described in terms of fundamental values of four distinct research traditions and the communities that bring the values and methods: of those research traditions to their investigations. Blends between communities indicate that mutual influence has occurred as interruptions research has progressed. It is clear from this review that there is no single or privileged perspective to study interruptions. Instead, these findings suggest that researchers investigating interruptions in healthcare would benefit from being more aware of different perspectives from their own, especially when they consider workplace interventions to reduce interruptions

Use of a big data analysis technique for extracting HRA data from event investigation reports based on the Safety-II concept

The safe operation of complex socio-technical systems including NPPs (Nuclear Power Plants) is a determinant for ensuring their sustainability. From this concern, it should be emphasized that a large portion of safety significant events were directly and/or indirectly caused by human errors. This means that the role of an HRA (Human Reliability Analysis) is critical because one of its applications is to systematically distinguish error-prone tasks triggering safety significant events. To this end, it is very important for HRA practitioners to access diverse HRA data which are helpful for understanding how and why human errors have occurred. In this study, a novel approach is suggested based on the Safety-II concept, which allows us to collect HRA data by considering failure and success cases in parallel. In addition, since huge amount of information can be gathered if the failure and success cases are simultaneously involved, a big data analysis technique called the CART (Classification And Regression Tree) is applied to deal with this problem. As a result, it seems that the novel approach proposed by combining the Safety-II concept with the CART technique is useful because HRA practitioners are able to get HRA data with respect to diverse task contexts

The contribution of creativity of action to safety: the key role of requisite imagination

International audienceThe aim of this paper is to show that requisite imagination by designers and more broadly by all workers – the ability to wonder and imagine key aspects of the future we are planning/designing – can be considered as a manifestation of creative action in organization and should be encouraged. We conducted an intervention in a nuclear power plant facing with a new nationwide policy seeking to extend the lifespan of nuclear facilities through important alterations. The first alteration made turned out badly, due to poor anticipation and a focus on technical effects, whilst organizational aspects were largely excluded. We decided to facilitate the conduct of a collective inquiry with the stakeholders involved with these ongoing evolutions, to discuss organizational design and stimulate requisite imagination. We discuss our main finding from three perspectives: theoretical, methodological and practical