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.

In the kingdom of the blind: successfully implementing institutional repositories in the UK and the SHERPA Partnership experience

This paper takes an overview of the work of SHERPA team and the SHERPA Partnership institutions in the area of developing, populating and maintaining institutional open access repositories. Crucial to this work has been the development of mutually supporting and enabling Partnership community, something which has been now recognised as needed by institutions who lie outside of it. To this end SHERPA is involved in efforts to support the individuals and institutions across the UK and Europe whom are engaging with the open access agenda on a practical level; through setting up community networks and disseminating experience. Key in the experience of the Partnership has been the role of advocacy of open access and repositories to the institutional research community. Whilst this experience has been unique to each institution, there are many shared lessons and best practice that the Partnership has recently reflected on, and that are articulated within this paper. Finally brief coverage on some of the vital community tools developed and maintained by SHERPA, and reflections on the evolving direction of open access in the UK are made.