The paper’s abstract reads:

Healthcare systems are under stress as never before. An aging population, increasing complexity and comorbidities, continual innovation, the ambition to allow unfettered access to care, and the demands on professionals contrast sharply with the limited capacity of healthcare systems and the realities of financial austerity. This tension inevitably brings new and potentially serious hazards for patients and means that the overall quality of care frequently falls short of the standard expected by both patients and professionals. The early ambition of achieving consistently safe and high-quality care for all has not been realised and patients continue to be placed at risk. In this paper, we ask what strategies we might adopt to protect patients when healthcare systems and organisations are under stress and simply cannot provide the standard of care they aspire to.

Discussion Points:

Extrapolating out from the healthcare focus to other businesses
This paper was published pre-pandemic
Adaptations during times of extreme stress or lack of resources - team responses will vary
People under pressure adapt, and sometimes the new conditions become the new normal
Guided adaptability to maintain safety
Substandard care in French hospitals in the study
The dynamic adjustment for times of crisis vs. long-term solutions
Short-term adaptations can impede development of long-term solutions
Four basic principles in the paper:
Giving up hope of returning to normal
We can never eliminate all risks and threats
Principal focus should be on expected problems
Management of risk requires engagement and action at all managerial levels
Griffith university’s rules on asking for an extension…expected surprises
Middle management liaising between frontlines and executives
Managing operations in “degraded mode” and minimum equipment lists
Absolute safety - we can’t aim for 100% - we need to write in what “second best” covers
Takeaways:
Most industries are facing more pressure today than in the past, focus on the current risks
All industries have constant risks and tradeoffs - how to address at each level
Understand how pressures are being faced by teams, what adaptations are acceptable for short and long term?
For expected conditions and hazards, what does “second best” look like?
Research is needed around “degraded operations”
Answering our episode question: The wrong answer is to only rely on the highest standards which may not be achievable in degraded operations

Quotes:

“I think it’s a good reflection for professionals and organistions to say, “Oh, okay - what if the current state of stress is the ‘new normal’ or what if things become more stressed? Is what we’re doing now the right thing to be doing?” - David

“There is also the moral injury when people who are in a ‘caring’ profession and they can’t provide the standard of care that they believe to be right standard.” - Drew

“None of these authors share how often these improvised solutions have been successful or unsuccessful, and these short-term fixes often impede the development of longer-term solutions.” - David

“We tend to set safety up almost as a standard of perfection that we don’t expect people to achieve all the time, but we expect those deviations to be rare and correctable.” - Drew

Resources:

The Safety of Work Podcast

The Safety of Work on LinkedIn

Feedback@safetyofwork

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