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Multi-level strategies to achieve resilience for an organisation operating at capacity: a case study at a trauma centre

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Abstract

Healthcare services are examples of organisations that operate frequently at capacity, as reflected by periods of high demand and hospital overcrowding. Using the safe operating envelope framework (Qual Saf Health Care 14:130–134, 2005), this study identifies the strategies hospital staff use to respond to high patient demand pressures. A surgical unit (SU) in a dedicated trauma hospital provides the context for the study. Results are based on the outcomes of structured, critical decision method and contextual interviews involving six participants selected according to their roles in relation to resource allocation within the SU. The study’s central findings are (1) that temporally nested patterns of emergency patient admissions are the dominant influence on three levels of management decision making in the SU and (2) that compensatory buffers are actively planned at multiple levels of work organisation. These results are discussed in terms of their theoretical implications and implications for technological design. The methodological limitations of the research are also discussed.

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Abbreviations

CRNA:

Certified registered nurse anaesthetist

RN:

Registered nurse

SU:

Surgical unit

TRU:

Trauma resuscitation unit

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Acknowledgments

This research was partly funded by National Science Foundation of the United States (ITR-0081868 and 0325087). Opinions are those of the authors and do not necessarily reflect the official position of the sponsor. The researchers acknowledge the influence of conversations with Prof. Penelope Sanderson and Dr Rizah Memisovich in relation to ideas about temporal decomposition in constraint-based modelling.

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Authors and Affiliations

  1. ARC Key Centre for Human Factors and Applied Cognitive Psychology, The University of Queensland, McElwain Building (24A), St Lucia Campus, Brisbane, QLD, 4072, Australia

    Anne Miller

  2. School of Medicine, University of Maryland, Baltimore, MD, USA

    Yan Xiao

Authors
  1. Anne Miller
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  2. Yan Xiao
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Corresponding author

Correspondence to Anne Miller.

Appendices

Appendix 1. Representative quotations: Director’s interview

Table 7.

Table 7  
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Appendix 2. Representative quotations: Schedulers’ interviews

Table 8.

Table 8  
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Appendix 3. Representative observations and quotations: Charge Nurses’ (CN) interviews

Table 9.

Table 9  
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Miller, A., Xiao, Y. Multi-level strategies to achieve resilience for an organisation operating at capacity: a case study at a trauma centre. Cogn Tech Work 9, 51–66 (2007). https://doi.org/10.1007/s10111-006-0041-0

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