Safety and complexity: the inter-departmental threats to patient safety in the operating department

Purpose: Current thinking about ‘patient safety’ emphasises the causal relationship between the work environment and the delivery of clinical care. This research draws on the theory of Normal Accidents to extend this analysis and better understand the ‘organisational factors’ that threaten safety. Methods: Ethnographic research methods were used, with observations of the operating department setting for 18 month and interviews with 80 members of hospital staff. The setting for the study was the Operating Department of a large teaching hospital in the North-West of England. Results: The work of the operating department is determined by inter-dependant, ‘tightly coupled’ organisational relationships between hospital departments based upon the timely exchange of information, services and resources required for the delivery of care. Failures within these processes, manifest as ‘breakdowns’ within inter-departmental relationships lead to situations of constraint, rapid change and uncertainty in the work of the operating department that require staff to break with established routines and work with increased time and emotional pressures. This means that staff focus on working quickly, as opposed to working safely. Conclusion: Analysis of safety needs to move beyond a focus on the immediate work environment and individual practice, to consider the more complex and deeply structured organisational systems of hospital activity. For departmental managers the scope for service planning to control for safety may be limited as the structured ‘real world’ situation of service delivery is shaped by inter-department and organisational factors that are perhaps beyond the scope of departmental management.

Compounds, creativity and complexity in climate change communication: the case of ‘carbon indulgences’

This article deals with climate change from a linguistic perspective. Climate change is an extremely complex issue that has exercised the minds of experts and policy makers with renewed urgency in recent years. It has prompted an explosion of writing in the media, on the internet and in the domain of popular science and literature, as well as a proliferation of new compounds around the word ‘carbon’ as a hub, such as ‘carbon indulgence’, a new compound that will be studied in this article. Through a linguistic analysis of lexical and discourse formations around such ‘carbon compounds’ we aim to contribute to a broader understanding of the meaning of climate change. Lexical carbon compounds are used here as indicators for observing how human symbolic cultures change and adapt in response to environmental threats and how symbolic innovation and transmission occurs.

Database-backed library web sites: a case study of the use of PHP and MySQL at the University of Nottingham

This paper discusses the advantages of database-backed websites and describes the model for a library website implemented at the University of Nottingham using open source software, PHP and MySQL. As websites continue to grow in size and complexity it becomes increasingly important to introduce automation to help manage them. It is suggested that a database-backed website offers many advantages over one built from static HTML pages. These include a consistency of style and content, the ability to present different views of the same data, devolved editing and enhanced security. The University of Nottingham Library Services website is described and issues surrounding its design, technological implementation and management are explored.