Abstract
The purpose of this study was to examine how Hollnagel's efficiency-thoroughness trade-off or ETTO principle (Hollnagel, The ETTO principle: efficiency-thoroughness trade-off. Ashgate Publishing Ltd, Farnham, 2009) can inform our understanding of the organisational strategies used to manage bed and staff resources in an Intensive Care Unit (ICU). We conducted a field study involving observations, interviews and analysis of artefacts used by the rostering nurse and nurse-in-charge of an ICU in a large metropolitan hospital. We identified five organisational strategies used by the nurses to maintain balance between efficiency and thoroughness demands: (a) a flexible unit-based staffing policy, (b) a theatre coordination rule, (c) a set of bed and staff (re)distribution options, (d) patient bed location preferences, and (e) staffing allocation order preferences. Our findings show that the ETTO principle is a useful descriptive model for understanding the factors that make organisational strategies successful. We also suggest how ideas from the organisational literature can enrich future research on the ETTO principle.
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Acknowledgments
This research was supported by Australian Research Council Grant DP0880920 to Sanderson and Venkatesh. We thank the staff members in the Princess Alexandra Hospital Intensive Care Unit for their time and support.
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Xiao, T., Sanderson, P., Clayton, S. et al. The ETTO principle and organisational strategies: a field study of ICU bed and staff management. Cogn Tech Work 12, 143–152 (2010). https://doi.org/10.1007/s10111-010-0147-2
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DOI: https://doi.org/10.1007/s10111-010-0147-2