Adelaide Nascimento

Producing effective treatment, enhancing safety: Medical physicists’ strategies to ensure quality in radiotherapy

The purpose of this article is to understand the way in which medical physicists take into account treatment effectiveness and safety when selecting a treatment plan, with respect to the medical prescription and the technical, human and organizational resources available. Data-gathering was based on the allo-confrontation method: 14 medical physicists from five different treatment centers commented on real treatment plans that had been drawn up by their colleagues. Results show that medical physicists have two means at their disposal to control treatment effectiveness and safety: risk avoidance and risk reduction. Risk avoidance is achieved when conceiving the treatment solution. Risk reduction occurs after the design of the plan and consists in accompanying and assisting the radiographers at the workstation where the treatment is carried out.

Designing the safety of healthcare. Participation of ergonomics to the design of cooperative systems in radiotherapy

This communication deals with the involvement of ergonomists in a research-action design process of a software platform in radiotherapy. The goal of the design project is to enhance patient safety by designing a workflow software that supports cooperation between professionals producing treatment in radiotherapy. The general framework of our approach is the ergonomics management of a design process, which is based in activity analysis and grounded in participatory design. Two fields are concerned by the present action: a design environment which is a participatory design process that involves software designers, caregivers as future users and ergonomists; and a reference real work setting in radiotherapy. Observations, semi-structured interviews and participatory workshops allow the characterization of activity in radiotherapy dealing with uses of cooperative tools, sources of variability and non-ruled strategies to manage the variability of the situations. This production of knowledge about work searches to enhance the articulation between technocentric and anthropocentric approaches, and helps in clarifying design requirements. An issue of this research-action is to develop a framework to define the parameters of the workflow tool, and the conditions of its deployment.

Quality in radiotherapy: effective treatment and patient safety.

The purpose of this article is to understand the way in which medical physicists take into account treatment effectiveness and safety when selecting a treatment plan, with respect to the medical prescription and the technical, human and organizational resources available. Data-gathering was based on the allo-confrontation method: 14 medical physicists from five different treatment centers commented on real treatment plans that had been drawn up by their colleagues. Results show that medical physicists have two means at their disposal to control treatment effectiveness and safety: risk avoidance and risk reduction. Risk avoidance is achieved when conceiving the solution. Risk reduction occurs after the design of the plan and consists in accompanying and assisting the radiographers at the work station where the treatment is carried out.

Performance-based management and quality of work: an empirical assessment

In France, in the private sector as in the public sector, performance-based management tends to become a norm. Performance-based management is supposed to improve service quality, productivity and efficiency, transparency of allotted means and achieved results, and to better focus the activity of employees and of the whole organization. This text reports a study conducted for the French Ministry of Budget by a team of researchers in ergonomics, sociology and management science, in order to assess the impact of performance-based management on employees, on teams and on work organization. About 100 interviews were conducted with employees of all categories and 6 working groups were set up in order to discuss and validate or amend our first analyses. Results concern several aspects: workload and work intensification, indicators and performance management and the transformation of jobs induced by performance management.

From prescribed to real rotations: a means of collective protection for the health of workers in a soft drink factory.

This article describes a particular way developed by employees to respond to the constraints of a very restrictive manufacturing plant: the mutual cooperation. Facing a very strict organizational context, the production workers can only rely on themselves to cope with the constraints of work. In this context, a complex system of strategies is deployed, resulting in a work environment governed by the sense of collaboration and mutual cooperation. The objectives of the implemented strategies, however, go beyond the attempts to reduce the work overload. They may be linked to a way of maintaining high levels of productivity and a way for workers to keep their jobs. We hope to contribute, through this study, to the general knowledge of the strategies developed by workers in production lines in order to minimize the pains.

The Making of Robust Schedules: Strategies to Dealing with Uncertainties

The abstract should summarize the contents of the paper in short terms, i.e. 150–250 words.

Constructing Quality of Care in Neurology: Anticipation Strategies of a Team of Nurses

Neurological patients are characterized by multiple handicaps and by physical, behavioral, and psychological symptoms that are diverse and fluctuating. They need specialized, multidisciplinary and constant health care, a large amount of hygiene care and technical care, but also relational care. The objective of this communication is to present the anticipatory operative strategies used by a team of nurses working in a neurology hospitalization sector and their representations of healthcare quality. Healthcare quality is studied from the constructive perspective of activity ergonomics: it considers quality as a permanent process on-going in the work situation, articulating the effective conditions provided by the organization for the realization of work-as-imagined and the individual and collective resources available by the agents who deal with the actual context. The methodology used is based on an exploratory field study using the clinical method of work analysis in ergonomics. The results show that quality is the result of arbitrations and individual and collective adjustments built in context, which incorporate formal and informal standards of care quality according to the content of care, the type of patient and the current state of the latter. The strategies identified allow the agents to reconcile in more or less satisfactory ways the different existing standards.

Ergonomics and Regulation: The Case of Job Rotation in a Brazilian Slaughterhouse

In April 2013, Regulatory Standard 36 was published in Brazil, concerning health and safety at work in slaughtering and meat processing companies, aiming to establish, among other things, standards for the implementation of job rotation. This industry has expanded in Brazil, which is currently the world’s largest exporter of beef. This work presents partial data from a survey carried out in a cattle slaughterhouse located in the state of Sao Paulo, Brazil. The purpose of this communication is to present the acceptance of the slaughterworkers regarding the rotation of posts imposed by the legislation, as well as to identify the determinants of the work. According to the data obtained, the slaughtering sector is composed of 88 workers, of which 91% are male and 47% aged 40 to 54 years. The most common causes of absenteeism in last two years were inguinal and abdominal hernias. The most significant determinants of labor are: product variation (cattle differences), cadence and irregular work rate, and physical and psychological demands. Knives, the main work tools, require time to be cleaned and sharpened. Concerning acceptance of the rotation, 30% of the workers are in favor, as they will learn new activities, and 70% are contrary as they believe they will be more exposed to work accidents in activities for which they do not have specific skills. It is concluded that detailed analysis of the posts, with the effective participation of the workers, are the main steps to comply with current legislation and preserve health at work and reduce the number of accidents and occupational diseases.