Vanina Mollo

Sociotechnical systems analysis in health care: a research agenda

Given the complexity of healthcare and the ‘people’ nature of healthcare work and delivery, STSA (Sociotechnical Systems Analysis) research is needed to address the numerous quality of care problems observed across the world. This paper describes open STSA research areas, including workload management, physical, cognitive and macroergonomic issues of medical devices and health information technologies, STSA in transitions of care, STSA of patient-centered care, risk management and patient safety management, resilience, and feedback loops between event detection, reporting and analysis and system redesign.

Work debate spaces: A tool for developing a participatory safety management.

In recent years, various studies have shown the importance of instituting work debate space within companies in order to address constraints within the organization. However, few of these studies demonstrate the implementation methods of discussion spaces and their contributions. Based on the action research developed in an electric company, this article demonstrates how work debate space (WDS) contribute to the development of an integrated safety culture. After describing the establishment methods and function of WDS within a technical group, we will present the main benefits of these spaces for the organization and its employees, and then discuss the minimal conditions for their implementation.

The development of collective reliability: a study of therapeutic decision-making

Therapeutic decisions in oncology are no longer the product of individual expertise but of evidence-based medicine (EBM). The objective of evidence-based medicine is to improve the quality of care and homogenize medical practices. Practitioners have two decision-making aids: the guidelines, which consist of a set of therapeutic rules created by experts of the domain; and the Pluridisciplinary Conciliation Committee, which gathers a set of practitioners of various specialties in order to examine situations that cannot be solved by the sole and strict application of the guidelines. During these meetings, different solutions proposed by the practitioners are confronted and evaluated. This research aims at understanding the implicit effects of such a collective confrontation on knowledge construction, both at the individual and collective levels. A two-step methodology of knowledge elicitation has been carried out. In the first step, 19 practitioners were asked to think aloud, while solving 14 experimental realistic problems. In the second step, practitioners were confronted with the solutions of their colleagues and asked to comment about them (individual allo-confrontations). The results show that the benefits of the collective confrontation go beyond the decision-making aid. It ensures the reliability of decisions in developing a collective frame of reference for adaptation knowledge, while leading to individual knowledge development.

La gestion des risques en radiothérapie

Radiation therapy was one of the first medical specialities to implement quality assurance (QA) programs in clinical practice. These QA programs have mainly focused on equipment performance neglecting human factors. Risk management is a relatively new approach in medical disciplines. Methods of evaluation and risk management must be identified, applied and adapted to the specificities of this domain. Based on the experience of industry, risk management will allow us to substantially improve safety and develop our own models of management. Recent experiences use these approaches to implement risk management in radiation therapy departments.

Managing patients’ demands: the practitioners’ point of view

Therapeutic decision-making is an activity of service during which practitioners and patients cooperate to reach decisions in agreement with patients demands and with clinical evidence. This paper presents the evolution of the models of service both in the medical domain and in the ergonomics literature. A study of the way in which practitioners take into account patients’ demands in decision-making is then presented. It considers both situations in which the patients make specific demands and those in which they do not. Results emphasize that the participation cannot be regarded as a stable prerequisite, but as a singular dynamic construction that evolves all along therapeutic care. The objective of this constructive process is to define the level of participation that best fits the interests of both patients and practitioners. Moreover, changing the practices of practitioners is not a sufficient condition to improve patients’ participation; the latter have also to be trained in order to become partners of the service interaction.

La gestion des risques en radiothérapieRisk assessment in radiation therapy

Radiation therapy was one of the first medical specialities to implement quality assurance (QA) programs in clinical practice. These QA programs have mainly focused on equipment performance neglecting human factors. Risk management is a relatively new approach in medical disciplines. Methods of evaluation and risk management must be identified, applied and adapted to the specificities of this domain. Based on the experience of industry, risk management will allow us to substantially improve safety and develop our own models of management. Recent experiences use these approaches to implement risk management in radiation therapy departments.