Supporting Safety in Health Care Transformations

Health care is in dramatic transformation due to the rapid development and massive implementation of (high- and low-tech) technologies. But not all transformations are as intended. Research in health transformation has disclosed new sources of risk and unpredictability, which require more research and organizational adjustment, i.e. learning. However, unintended consequences and effects occur at different levels of interaction and collaboration, requiring corresponding adjustment and learning strategies. - On the background of an ethnographic study of support-work in surgery in different Danish hospitals, this paper analyses cognitive-socio-technical health care practices as learning ecologies, giving special attention to the intentional and unintentional roles of technologies herein and their context dependency. The paper argues for an increased awareness of support at different contextual levels of use, presenting three examples from the study as learning cases. The three cases exemplify instances of disruption of the workflow and the collaboration among clinicians. They display how these instances are taken as challenges requiring learning at different levels in order to live up to the overall purpose, which is to reestablish safety - in the team and for the patient.