. "Appendix B: Interdisciplinary Collaboration, Team Functioning, and Patient Safety." Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington, DC: The National Academies Press, 2004.
The following HTML text is provided to enhance online
readability. Many aspects of typography translate only awkwardly to HTML.
Please use the page image
as the authoritative form to ensure accuracy.
Keeping Patients Safe: Transforming the Work Environment of Nurses
excessive. When approaching this boundary, employees develop work shortcuts to reduce the perceived threat. The psychological boundary represents conditions in which mental effort, stress, or anguish is unacceptable. Safety protection behaviors when approaching this boundary include withdrawal and aggressive action. The social boundary clarifies the limits of acceptable group norms and behavior and may include legal or corporate expectations for performance. The economic boundary indicates where economic viability or security is threatened and when approached often leads to cost-cutting measures.
Strategies to keep teams and organizations functioning within the safety zone created by these boundaries involve designing robust structures that include attention to (1) redundancy, in which alternate paths are available to carry demands; (2) ductility, in which components are able to deform without failing and to shift demands to other paths when necessary; and (3) excess capacity, in which components are designed to carry demands beyond those normally expected. Full integration of these fail-safe measures requires the development of cohesive work teams that emphasize integrity, trust, and cooperation (Bea, 1998). Necessary also are sufficient training of members who have direct influence over the system’s safety; the development of positive economic and psychological incentives that promote safety behaviors; the development of effective internal and external checking and verification procedures; and standards of performance, including procedures for disciplinary action when rules are breached and the introduction of methods to promote early identification of and response to emerging risks.
According to this model, three approaches can be used to maximize consistent practice within teams and return to safe systems. The first is a reactive approach, which results in analysis of the failure or failures of the system. This process focuses on understanding the reasons for failure and how to avoid it in the future. Most commonly, the process results in the development of safety guidelines, procedures, and rules for performance (Bea, 1998). The proactive approach works to analyze the system before it fails and to put into place measures that prevent the anticipated failure. One of the difficulties with this approach is its focus, which directs attention to what may go wrong rather than what is working right. For this reason, Bea adds a third approach, which he believes needs further development and exploration. This real-time approach stresses the responses that occur during a crisis when a buildup of danger signals requires immediate action to return the system to its normal state. The real-time approach recognizes those situations in which the sequence of events or the novelty of the situation is unpredictable and different from previous experiences. In this scenario, employees are provided with enhanced abilities to rescue themselves from the threatening event and to return the system to its usual safe state. Training, including the use of simulation techniques, is the most use-