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Resilient Health Care: Muddling Through with Purpose

I: Openings Introduction: How We Got Here The Necessity of Muddling Through The Historical Context Logic and Rationalism Homo Economicus The Practical Challenges Muddling Through During a Crisis References II: Case Studies of Muddling Managing Complexity and Manifestations of Resilience in Operating Theatres: Sensemaking and Purposive Muddling Among Scheduling Nurses Research Design and Methods Research Setting Research Design Data Analysis Framework Results In the Eye of the Storm Visibility of Processes, Outcomes and Consequences of Change Organising with Slack Diversity in Decision-Making Work-as-Done and Work-as-Imagined Discussion Conclusion References Re-designing the Blood Transfusion Procedure in Operating Theatres: Aligning Work-as-Imagined and Work-as-Done An Incident Report and Work-as-Imagined – Work-as-done An Incident Report Work-as-Imagined (Hospital-Wide Rules)Work-as-Done (Operating Theatres Everyday Practice)Muddling Through Decision and Its Reasons Blood Transfusion Policy Unintended Feedback Reconciling the Gap Round Table Discussion Perception of the Present Procedure Creating Consensus Through Shared Value Questionnaire Surveys Educational Visit Discussion References Dynamic Performance of Emergency Medical Teams as Seen in Responses to Unexpected Clinical Events Case Study: Response to Multiple Casualties Contact from the Ambulance Dispatch Centre Preparation for Receiving Casualties (Staff, Place and Equipment)Unexpected Patient Receiving the Casualties From Initial Treatment to Definitive Care Flexible Team Response to the Unexpected Clinical Event Organisms that Change Their Shape Adjusting to the Situation Collapsible and Scalable Medical Teams: Medical Teams that Change ‘Shape’ According to the Situation Role of the Leader Learning Organisation Interpretation Conclusion References From Mortality and Morbidity Conference to Quality Assessment Meeting: Step-by-Step Improving Team Resilience The Traditional Mortality and Morbidity Conference The Need for a Novel Format for Mortality and Morbidity Conferences The Quality Assessment Meeting The QAM Meeting to Address the Potentials for Resilient Performance Future Improvements References Images of Work-as-Imagined Introduction Methods Findings External-Formal Work-as-Imagined External-Informal Sources of Work-as-Imagined Internal Sources of Work-as-Imagined Discussion Conclusion References III: The Functional Resonance Analysis Method (FRAM) as a Gateway into Muddling with a Purpose Experiences with FRAM in Dutch Hospitals: Muddling Through with Models Applications of FRAM Where to Start?Modelling Work-as-Imagined and Work-as-Done Stakeholder Meetings and Improvement Initiatives Using FRAM to Reveal Muddling Through-Like Behaviour Muddling Through with Workarounds Muddling Through Using Personal Aids Muddling Through with Unclear or Unpractical Roles Usability of FRAM Suggested Framework for FRAM Model Interpretation Strengths of FRAM Challenges of FRAM Conclusion and Future Perspectives References Modelling a Typical Patient Journey Through the Geriatric Evaluation and Management Ward to Better Understand Discharge Planning Processes Method Functional Resonance Analysis Method (FRAM)Step 0 The Purpose and Scope of the Analysis Step 1 Describe Potential and Actual Performance Variability Step 2 Describe Potential and Actual Performance Variability Step 3 Aggregation of Performance Variability and Step 4 Propose Ways to Control Variability Results Describing the Clusters Cluster 1: To Prepare the Preliminary Discharge Plan To Refer the Patient To Intake To Admit the Patient To Do Initial Assessment To Provide Allied Health Service/To Provide Nursing Care/To Do Medical Ward Round/Review To Do Ongoing Assessment To Identify the Discharge Plan Cluster 2: The Resources Required for the Discharge Plan and Patient Supports Post-Discharge To Hold Case Review To Hold Family Meeting To Huddle To Hold Case Conference To Hold Feedback Meeting Cluster 3: Major Influences on the Discharge Plan and the Supports for the Patient Post Discharge To Engage the Patient To Prescribe the Formal Supports To Follow the Model of Care Cluster 4: Readying the Patient for Discharge To Organise Day of Discharge Resources To Confirm Clinical/Functional Stability To Notify Staff that Discharge is in Progress To Complete Discharge Paperwork To Arrange Transport To Ready the Patient for Discharge Cluster 5: Discharging the Patient from the Ward To Discharge the Patient from the Ward To Transit to Destination Risk of Functional Resonance and Dampening the Performance Variability Missed Referrals Missing Information from Intake Delayed Assessments to Enable Formulation of the Discharge Plan Delayed Notification of Pending Discharge Key Features that Dampen Uncontrolled Performance Variability Model of Care Engagement with the Patient Daily Communication and Sharing of Information Discussion Practical Implications Research Implications Limitations References Muddling Through in the Intensive Care Unit: A FRAM Analysis of Intravenous Infusion Management FRAM Example: Intravenous Medication Ordering Conclusion Acknowledgements References Muddling Through the Built Environment to Preserve Patient Safety and Well-Being Built Environment in Intensive Care Units Research Method Scenario Data Collection Data Analysis Results Discussion Conclusion References IV: Muddling with Application: In and Around Hospitals Simulation to Surface Adaptive Capacity Where In Situ Simulation Fits in Adaptations, Pandemics and Simulation On Systems and Microsystems Discussion and Conclusion References Towards Safety-II in Hospital Care Using the Available Safety-I Environment: Patient-Level Linkage of Currently Available Hospital Data Current Use of Patient Safety Data Focussing on the Negative Real-World Complexity and Relations between Events Remain Obscured Connecting the Data Silos Material and Methods Revealing the Positive Target Groups Revealing Resilient Behaviour and Muddling at the Sharp End Conclusion References Peer-to-Peer Information Sharing for a High-Quality, Autonomous and Efficient Health Care System Gaps in Care Goals between Health Care Providers and Patients Increasing Recognition of Patient Engagement and Patient-Centred Care Problems in Decision-Making on Dialysis Modality Problems in Self-Management of Life-Long Illness A World Café Style-Workshop with PD Patients Setting and Development of the PD Café The Programme and Methods of the PD Café Effects of Peer-to-Peer Interactions Discussion Conclusion References ‘Muddling Through’ Care Transitions: The Role of Patients and Their Families ‘The Science of Muddling Through’ – What Can this Add to Our Understanding of Transitional Care?Successive Limited Comparisons Limit the Values to Be Optimised Same Values, Different Interpretation?Evaluating Success Is Not ‘Value-Neutral’Incrementalism Shapes Behaviour within Services Muddling Through Transition – The Staff Perspective Being Muddled Through Transition – The Patients’ Perspective Patients' Responsibilities in Hospital - A Quadruple-Edged Sword Self-Medication in Hospital – Whose Risk Is It Anyway?The Surprise of Discharge The Resilience of Patients and Families A Transitional Muddle – Combining these Perspectives Can We Systematically Support Patients and Families to Improve the Resilience of Transitional Care?The ‘Your Care Needs You’ Intervention Conclusion Acknowledgements References V: Closure Conclusion

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