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.

Further exploration of the Dendritic Cell Algorithm: antigen multiplier and time windows

As an immune-inspired algorithm, the Dendritic Cell Algorithm (DCA), produces promising performance in the field of anomaly detection. This paper presents the application of the DCA to a standard data set, the KDD 99 data set. The results of different implementation versions of the DCA, including antigen multiplier and moving time windows, are reported. The real-valued Negative Selection Algorithm (NSA) using constant-sized detectors and the C4.5 decision tree algorithm are used, to conduct a baseline comparison. The results suggest that the DCA is applicable to KDD 99 data set, and the antigen multiplier and moving time windows have the same effect on the DCA for this particular data set. The real-valued NSA with contant-sized detectors is not applicable to the data set. And the C4.5 decision tree algorithm provides a benchmark of the classification performance for this data set.