Understanding complex work using an extension of the resilience CARE model: an ethnographic study
Natalie Sanford1, Mary Lavelle2,3, Ola Markiewicz3
1The Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College, James Clerk Maxwell Building 1.32, 57 Waterloo Road, London, SE1 8WA, UK. Natalie.Sanford@kcl.ac.uk.
BMC Health Services Research
|September 6, 2022
Summary
Healthcare professionals adapt to demand-capacity misalignments using various strategies. This study identifies common misalignments and adaptations, offering insights to improve healthcare systems and patient safety.
Area of Science:
- Healthcare quality and safety research.
- Resilient Healthcare theory.
- Engineering principles in healthcare systems.
Background:
- Resilient Healthcare research focuses on improving healthcare quality and safety.
- The CARE model links demand, capacity, work, and outcomes.
- Understanding misalignments and adaptations is crucial but not fully described.
Purpose of the Study:
- To identify and classify types of demand-capacity misalignments.
- To categorize adaptations used in response to these misalignments.
Main Methods:
- Ethnographic observations (88.5 hours) in a London teaching hospital.
- Data collection through direct observation and interviews with healthcare professionals.
- Thematic analysis of field notes using a deductive-inductive approach based on the CARE model.
Main Results:
- 365 demand-capacity misalignments identified across five hospital wards.
- 212 misalignments had observed work adaptations.
- Common misalignments included equipment, staffing, and process; adaptations involved process changes, resource redistribution, and extra-role performance.
Conclusions:
- A refined CARE model incorporating misalignments and adaptations is proposed.
- This model aids in understanding work-as-done and system complexity.
- Insights can inform work system redesign and adaptive capacity enhancement for improved healthcare.
More Related Videos
Related Concept Videos
01:15Methods of Documentation VI: Case Management Model
619
The case management model is a multidisciplinary approach that involves healthcare professionals from diverse disciplines, such as physicians, nurses, therapists, social workers, and pharmacists, working collaboratively to address the various needs of patients. Each healthcare professional brings unique expertise and perspectives, contributing to a more comprehensive understanding of the patient's condition and tailoring treatment plans accordingly.
For example, a patient with a chronic...
For example, a patient with a chronic...
619
01:26Modeling in Therapy
139
Modeling, a key technique in therapy, uses observational learning to help clients acquire and practice new skills by watching therapists demonstrate desired behaviors. This approach, rooted in Albert Bandura's concept of vicarious learning, plays a significant role in therapeutic interventions for various psychological conditions, including social anxiety, ADHD, and depression.
Participant Modeling
Participant modeling involves therapists demonstrating calm and effective behaviors in...
Participant Modeling
Participant modeling involves therapists demonstrating calm and effective behaviors in...
139
01:27Ethnic Identity within a Larger Culture
77
Adolescents from ethnic minority backgrounds face a multifaceted journey in forming their identities, shaped by the intersections of cultural expectations and personal exploration. For these adolescents, identity formation involves not only typical developmental challenges but also navigating the perceptions and attitudes of the majority culture. As they grow, adolescents in ethnic minority groups often become increasingly aware of stereotypes, social biases, and discrimination, all of which...
77
01:29Documentation in Long-Term and Home Healthcare Setting
967
Documentation in long-term care facilities and home healthcare settings is crucial for ensuring continuous, coordinated, and comprehensive care for patients. Each setting has its specific documentation processes and tools:
Long-Term Care Facilities
Long-Term Care Facilities
967
01:18Interdisciplinary Care: The Health Care Team-II
1.5K
An interdisciplinary team includes many healthcare professionals working together and utilizing their skills, knowledge, and expertise to provide holistic and quality patient care. Here are a few more healthcare professionals.
Physical Therapist
A physical therapist (PT) aims to restore function or prevent additional impairment in a patient following an injury or disease. Massage, heat, cold, water, sonar waves, exercises, and electrical stimulation are some treatments used by PTs to treat...
Physical Therapist
A physical therapist (PT) aims to restore function or prevent additional impairment in a patient following an injury or disease. Massage, heat, cold, water, sonar waves, exercises, and electrical stimulation are some treatments used by PTs to treat...
1.5K
01:21Interdisciplinary Care: The Health Care Team-I
1.8K
An interdisciplinary team includes many healthcare professionals working together and utilizing their skills, knowledge, and expertise to provide holistic and quality patient care.
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution...
Physicians
The physician's primary responsibility is to diagnose illness and direct the medical or surgical treatment of the condition. The authority to admit patients to a healthcare agency or institution and practice care within that setting is granted to physicians by the healthcare agency or institution...
1.8K