Reducing latent errors, drift errors, and stakeholder dissonance

Healthcare information technology (HIT) is being offered as a transformer of modern healthcare delivery systems. Some believe that it has the potential to improve patient safety, increase the effectiveness of healthcare delivery, and generate significant cost savings. In other industrial sectors, information technology has dramatically influenced quality and profitability - sometimes for the better and sometimes not. Quality improvement efforts in healthcare delivery have not yet produced the dramatic results obtained in other industrial sectors. This may be that previously successful quality improvement experts do not possess the requisite domain knowledge (clinical experience and expertise). It also appears related to a continuing misconception regarding the origins and meaning of work errors in healthcare delivery. The focus here is on system use errors rather than individual user errors. System use errors originate in both the development and the deployment of technology. Not recognizing stakeholders and their conflicting needs, wants, and desires (NWDs) may lead to stakeholder dissonance. Mistakes translating stakeholder NWDs into development or deployment requirements may lead to latent errors. Mistakes translating requirements into specifications may lead to drift errors. At the sharp end, workers encounter system use errors or, recognizing the risk, expend extensive and unanticipated resources to avoid them.     

Urban bird conservation: presenting stakeholder-specific arguments for the development of bird-friendly cities

Following the call from the United Nations Convention on Biological Diversity “Cities & Biodiversity Outlook” project to better preserve urban biodiversity, this paper presents stakeholder-specific statements for bird conservation in city environments. Based upon the current urban bird literature we focus upon habitat fragmentation, limited habitat availability, lack of the native vegetation and vegetation structure as the most important challenges facing bird conservation in cities. We follow with an overview of the stakeholders in cities, and identify six main groups having the greatest potential to improve bird survival in cities: i) urban planners, urban designers and (landscape) architects, ii) urban developers and engineers, iii) homeowners and tenants, iv) companies and industries, v) landscaping and gardening firms, vi) education professionals. Given that motivation to act positively for urban birds is linked to stakeholder-specific advice, we present ten statements for bird-friendly cities that are guided by an action perspective and argument for each stakeholder group. We conclude with a discussion on how the use of stakeholder-specific arguments can enhance and rapidly advance urban bird conservation action.     

Recognizing nurse stakeholder dissonance as a critical determinant of patient safety in new healthcare information technologies

Proper identification of all stakeholders and the comprehensive assessment of their evolving and often conflicting Needs, Wants, and Desires (NWDs) is a fundamental principle of human factors science and human-centered systems engineering; it is not yet a consistent element in development and deployment of new health information technologies (HIT). As the single largest group of healthcare professionals, nurses are critical stakeholders for these new technologies. Careful analysis can reveal nurse stakeholder dissonance (NSD) when integrating new technologies into the healthcare environment. Stakeholder dissonance is a term that describes the conflict between the NWDs of different stakeholders which, if left unresolved, can result in dissatisfaction, workarounds, errors, and threats to patient safety. Three case studies drawn from the authors' experience in a variety of acute-care settings where new HITs have been recently deployed are examined to illustrate the concept of NSD. Conflicting NWDs, other stakeholders, and possible root causes of the NSD are analyzed and mapped to threats to patient safety. Lessons learned, practical guidance for anticipating, identifying, and mitigating NSD, future research and implications for HFE and nursing practice are discussed.     

Representing employee requirements in labour tour scheduling

In this paper, we use the methodology of simulation to evaluate six approaches for handling employee requirements in an LP-based labour tour scheduling heuristic. We model employee requirements both as minimum acceptable staffing levels—where understaffing is unacceptable—and as target staffing levels—where both under- and overstaffing are acceptable. For each representation of employee requirements, we evaluate forms of the heuristic that use problem-specific and problem-independent information on the costs of employee surpluses and, if appropriate, employee shortages. Over an extensive test data set, the target-staffing approach using problem-specific cost information outperformed all other procedures. Specifically, it generated schedules costing less than 87% of those developed using the approach most commonly found in the literature. Its schedules were also almost 5% cheaper than those of its closest competitor. We discuss the managerial and research implications of the findings and provide suggestions for future research.